Nepal Medical Council
National Academy of Medical Sciences (NAMS)
Medicine and Health Care
Family Medicine (General Practice) is perhaps the most important, but least recognised specialist discipline of medicine in Nepal. It is important because the great majority of the population of Nepal, mostly in rural areas, have no access to a doctor of any sort.
They should be able to meet a doctor who has a broad background of training, who understands them and knows how best to meet their need in a comprehensive way, recognising what is possible and affordable in that context. It has been demonstrated that family practitioners are the most effective doctors for providing primary health care.
The doctor at the District Hospital should be a Family Medicine Practitioner, one who has done advanced training to be equipped for competent independent practice in this setting. The Family Doctor will manage many conditions in a simple and competent way and will have the practical skills that are needed, including general surgery, obstetrics and anaesthetics.
One or two fully trained Family Doctors placed in the Primary Health Centre and District Hospital, are able to provide the sort of comprehensive holistic service that the people are looking for. As the service builds up, visiting specialists may also come. As their services are limited and specific, it is the Family Doctor who can best decide who needs the specialised services. In this way, the specialist is used in the most efficient way to benefit the greatest number. At the zonal hospital, family Practitioners are ideally placed to serve in Emergency Departments and in providing primary care.
While the people in greatest need of service are those living in isolated rural areas, the other reality is that the towns and cities of Nepal are growing very quickly. As they develop, the need for primary medical service grows too. Random or market driven growth of specialist services with direct access by the public has been the pattern. This leads to fragmented patient care and inappropriate investigation which is less cost effective. The Family Doctor has much more to offer as the first point of call for town people. He/She will become known for continuous care of the family over a length of time. The Family Doctor will help the family to make wise choices about the use of their savings to restore, maintain and build the health of the family.
The Family Doctor will recognise the deficiencies in health services and advocate for their improvement with community members. The Family Doctor will see patterns of community health problems and work together with counterparts in that discipline to improve the health of the population as a whole. They are an important key to integrating curative and preventive services. There is wide agreement that strengthening district health systems is the most appropriate way to promote primary health care.
The district hospital in Nepal represents the point of convergence of the “top-down” approach of health service planning and the “bottom-up” approach of community participation. Cooperation between hospital and community health services will facilitate this functioning of an integrated District Health system. An adequate network of fully functional district and zonal hospitals will enable more effective referral network with reduction in inappropriate cases presented to tertiary hospitals.
The post graduate programme in Family Medicine will provide systematic training under the guidance of qualified Family Practitioners to produce generalist doctors with wide ranging skills and experience who:
1. Demonstrate competence in the management of acute and chronic health problems
2. Promote community health and prevent disease
3. Provide patient-centred care, rather than disease centred
4. Work cooperatively with other health professionals as part of a team
5. Demonstrate a professional attitude to their work
6. Demonstrate competence and enthusiasm for research
7. Demonstrate an ability to teach other health care workers
General entry criteria of National Academy of Medical Sciences for MD/MS program are applicable, which is as follows: