MD General Practice - National Academy of Medical Sciences (NAMS)

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.

GOALS

1. To produce compassionate, competent and patient-centred family doctors, able to provide all age groups with comprehensive and effective management of a wide range of health problems encountered in Nepal, including timely emergency and life-saving surgical and obstetrical intervention.
2. To improve the access of Nepali people, especially the poor and underserved, to appropriate health care by providing family doctors who can take up a range of career opportunities at all levels of public hospital (particularly as a District Health Officer and Primary Care Physician) and in the primary health care system as well as private medical practice.

OBJECTIVES

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

1. Performs emergency medical, surgical, trauma and obstetric procedures
2. Demonstrates particular skill in maternal and child health (including neonatal)
3. Provides continuity of care for ongoing medical problems
4. Arranges appropriate follow-up and referral

2. Promote community health and prevent disease

1. Includes health promotion/education in each patient encounter
2. Knows the local needs and patterns of disease - a practical epidemiologist
3. Act as advocates within and for the community to improve community health and development

3. Provide patient-centred care, rather than disease centred

1. Understands the social and cultural aspects of health and illness
2. Communicates well with patients and their family
3. Treats patients with compassion and respect
4. Makes ethical medical decisions

4. Work cooperatively with other health professionals as part of a team

1. Acts as a leader in the health team
2. Manages and administrates competently
3. Implements national health strategies
4. Co-ordinates with other agencies, using resources wisely and creatively
5. Co-ordinates with other health care professionals to optimize pt care

5. Demonstrate a professional attitude to their work

1. Understands own strengths and weaknesses
2. Committed to life-long learning
3. Committed to their local community
4. Maintains good relationships with specialists and other health care workers
5. Understands the health care system in Nepal and their role within it

6. Demonstrate competence and enthusiasm for research

1. Critically reads the literature
2. Initiates research or collaborates with others to address health care questions relevant to Nepal

7. Demonstrate an ability to teach other health care workers