Family Medicines: a Strategic Weakness Essay

Recently the trends of urbanization and steady universe increase expose several(prenominal)(prenominal) problems to wellnesscargon system in Vietnam the c ars of shortage of wellness maintenance manpower, menial choice of anguish, un dry land commensurate distri unlession of wellness assistance manpower in contrastive geographic aras, in particular the serious shortage of atomic spot 101s in Mekong Delta and north-west adenylic acidlyland atomic cast 18as as specia cites tend to range their executes in urban wellness check exam checkup exam centers where they could take in access to advanced engine room, supportive serve and consultations from former(a) specialists bit pastoral areas are underserved and diligent headache becomes highly technocratic, dis beau mondeed and episodic.Further much(prenominal)(prenominal), the shortage of atomic number 101s in study cities results in a seriously permanent congest at primaeval train and any(pren ominal) specialty hospitals a desire Oncology, Pediatrics, Obstetrics and gynaecology .. etc.. In sustainable issues, deficit of Family treat a elementary foundation of neo wellness reverence in the earthly concern, is identified as one of main characters of such(prenominal) problems in Vietnam health misgiving system.The purpose of this Essay is to translate a theoretical discussion and compendium slightly the Family medicinal drug weakness in wellness business organization system and Family atomic number 101 deficiency in Vietnam to erupt understand ab extinct their impacts to the health dish out system at innovate and or so proposed antecedents and recommendations to improve these deficits. 2. Family medicine and its graphemes in orbiculate health distri besidese system. In modern-day treat, Family music remains the foundation oppose of health alimony service in the community.As the close inte peaceing and challenging of medical disciplines it is based on six entire principles * main(a) vex * family upkeep * domiciliary tiller do * inveterate guardianship whole above principles are all intentional to achieve * pr take downtive worry * ad hominem bearing (Pereira Gray, 1980). In the contemporary temper where medical go are split up and there are competing interests there is a greater call for than ever for customaryists.In those principles, unproblematic explosive charge is the backbone of the health do system and encompasses the following ranges * It is elemental contact kick, serving as a point of entry for the tolerant into the health deal out system * It includes continuity by fairness of pity for perseverings in sickness and health everyplace near period * It is encyclopedic wish well, disgorgeing from all the traditional major(ip) disciplines for its functional content. It serves a coordinative function for all the health misgiving necessitate of the persevering of * It assumes co ntinuing responsibility for individual tolerant follow-up and community health problems * It is a high personalized type of share (Rakel 2011) In the 2008 written report, the creation health presidential term (WHO) affirmed the importance of immemorial health armorial bearing with its report original health care directly more(prenominal) than ever and its emphasizes that elemental care is the best way of contend with the illnesses of the 21st century, and that better expend of existent pr up to nowtive measures could veer the global institutionalise of ailment by as untold as 70%.The commentary emphasizes that basal care brings promotion and prevention, cure and care together in a safe, in effect(p) and lovingly productive way at the interface among the population and the health system. The key challenge is to regula line up people first since unspoilt care is about people (WHO, 2008). Rather than undirected from one short-term priority to a nonher, countr ies should grade prevention equally definitive as cure and focus on the rise in continuing diseases that require long-term care and well community support.Furthermore, at the 62nd universe health Assembly in 2009, WHO potently reaffirmed the values and principles of special health care as the background for beef up health care system gentleman full. The philia of Family radiation diagram of medical specialty is continuity of care and the licence for its contribution to lumber of care and better outcomes as follows * Lower all bring morbidity * Better access to care * Less re-hospitalization * Fewer consultations with specialists * Less use of emergency service Better investigator of adverse effects of medication interventions. eccentric definition of Family doc varies considerably some(prenominal) among family twists and among people with whom they interact. Some individuals, curiously other medical specialists, see family medicine as merely a nonher name o f general serve. For others, family medicine is synonymous with uncreated care. A large proportion of family physicians further dilate their role to include emphasis on personalized and humanized care.A smaller multitude adds a one-third component to their role caring for families. The largest proportion who subscribes to this last legal opinion refer to family physicians treating all members of a family (Cogswell, Sussman, 1982). In batch of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertness from five older specialties internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology.Compared to these specialties, family medicine is still a young theater marked both by rapid expansion and by change, variety, ambiguity and struggle in the images and definition of the role of family physician. As the largest caring mountain chain in healthcare services, the prime(prenominal) and standard strengths of Family physician drag play key roles to improve the health feeling of theme population. orbicularly the scope of Family medicine is extended with the recent view of global health care which is a field at the intersection of several disciplines epidemiology, economics, demography and sociology.The term global health, as distant to international health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. That means global health has wide scope and form-to doe with to equity that the term of international health. The global health pattern in Family medicine raises the changes in primal care personality as follows * All population has to green goddess with the same risk of health payable to the phenomena of traveling and immigration. growing the spreading in the midst of the wretched & international type Aere ampere the privileged globally. * The process of the urbanization/globaliza tion. * Increase of the population in the world. * Decrease of the resources for health care. * planetary warming phenomena. * Vaccination Era. * Evidence found Medicine in daily workout. * Increase the bad behavior such as fast food, tobacco, stress, use alcohol * primordial feather health care change to Primary care concept (Pham Le An, 2009). such(prenominal) all-round(prenominal) changes upgrade the scale of Family medicine in healthcare.In roam to usualize the global health support as well as strengthen the co-operation of national members, the adult male Organization of National colleges and Academies (WONCA), World Organization of Family physicians in WHO, was officially open up and based in Sin breakore after(prenominal) the Fifth World Conference on public Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 years, Family physicians, the or so latterly recognize d specialists in Vietnam, are in the enigmatic situation of develop the occupational role which they simultaneously occupy.Family medicine had been except approved for establishment by Vietnam Ministry of wellness since 2000. Until 2003, Family medicine specialty was established at 3 medical examination Universities of Hanoi, HCMC City and Tai Nguyen province to train Family physicians and its specialists. However, its development was extemporaneous with 7 Family medicine clinics (in both public and private sectors) nationwide and non strategically organized at all take aims so far.There are wholly 59 post- calibrated specialists and just about 1,1 habitual practitioners who partly grip the roles of family physicians per 10,000 people averagely. The imbalance between Family medicine and other specialists quarter be seen by the ratio of 7,2 medical exam twists per 10,000 people in overall (Vietnam habitual Statistics Office GSO 2011) and the healthcare system only sa tisfies about 60- 70% of the demands and are spurn than neighbor countries exchangeable Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of Health forecasted the demand of 34,000 General practitioners more to agree 10 medical exam have-to doe withs/10,000 people in 2020 and this is a prodigious challenge to all 19 medical checkup educational Universities/Colleges to educate Medical revivifys and post-graduate aims in medicine which capacities supplement 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year.Not only the quantity of family physicians is seriously insufficient, but similarly their woodland to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner tuition programs befoolt orient student to the WHOs critical requirements of good doctors in Family medicine, even though the criteria are more and more demanding by time, for example, the newer criteria of John Murtagh in 2001 What makes a good General Practitioner? * cultivate rapport and good chat skills * carry the right questions * Be astute and observing * Develop optimal ethical and skipper standards * Have a fail-safe diagnostic strategy * Develop supportive ne 2rks * survive essential therapeutics * Develop basic procedural skills * Be well prepared for emergencies * have a go at it yourself and your limitations including own general practitioners. The importance of real specific competences and soft-skills in family physician labor are emphasized in numerous studies.An interesting survey on patient care by representative health consumers conducted at St Vincents Hospital Melbourne revealed that the more or less important attributes of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, get it onledge, confidence, sensitivity, perceptiveness, diligence, availability and m anual skills. Additionally, there are neither comprehensive residence programs for Family physicians at Medical Universities/ Colleges in Vietnam nor musical accompaniment insurance to them and general practitioners practicing at impertinent or rural areas so far.With effort to crack up the overload situation of of import hospitals in major cities, Project 1816 of Vietnam Ministry of Health deployed in 2008 with the purpose of Fielding rotated professionals from f number level hospitals to trim levels to improve the quality of medical care achieved some sign results such as steerring some technologies and conducting on-site develop to improve skills and qualifications for spurn level health care professionals initially ameliorate the quality of medical care at lower levels, especially in the mountainous, remote areas with staff shortageetc, but its couldnt obtain one of basic goals to reduce overcrowding for upper level hospitals, especially primal level hospitals becau se it made the shortage of commutation level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in Healthcare system &amp Family physician deficiency in Vietnam.Due to low reliability and gravely structured family physician network, patients tend to go around to specialists/ central level hospitals (Vietnam Ministry of Health 2011 bill), opposite with the trend in the world in which healthcare activities for continuing diseases such as diabetes, hypertension, asthmaare moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The bit bypass causes the overload at Central level and specialty hospitals and the overloading condition becomes more serious, i. e, bed using capableness at Central hospitals increase from 116% (2009) to 120% (2010) and 118% (2011).Its extremely high in some specialty hospitals such as K (Cancer) Hospital 249%, Bach Mai Hospital 168% Cho ray ho spital 154% Central Obstetric and gynecologic hospital 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Orthopaedics (at 100% of hospitals), Obstetrics and Gynaecology, pediatrics (at 70% of hospitals) part 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor while 60% 80% of patients at Central level hospitals could be examined at topical anesthetic level and 40% of surgery cases at Central level hospital could be performed at local anesthetic levels (Ministry of Health visualize to decrease workload of Central level hospitals 2012- 2020)With the damage in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher(prenominal). agree Expenditure on health as % of GDP (5. 1) is moderately high while General Government disbursement on health as % of total expenditure on health (28. 5) is so low to neigh bor countries (Susan, 2005). The most cost-effective healthcare systems consider on a strong primary care base. This has been confirmed by a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians.When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is mutually proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economi c Cooperation and Development OECD Health Data, June 2005), join Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative viewgraph accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003).Countries with strong primary care have lower overall health care costs, improved health care outcomes, and fitter populations (Starfield, 2001 Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows * Incomplete or goalless Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties lack of cooperation in continuing disease care, increase the cost of management. * bar in teaching ambulatory care and doing out-patients interrogation in academies (Pham Le An, 2009). In purchase order, Family medicine meets some resistances of patients s uch as family hysicians are unfairly inured as general consultants, pedestal caring doctors and even in medical community, they are considered as incompetent doctor, poor specialist, unfair competitive doctor.. etc. Many other specialists and hospitals managements list Family physicians as one of monetary losing causes to their hospitals. such(prenominal) unfair treatments make many Family physicians detect uncomfortable with the specialty and their roles of Family physician. The reliability of patients and partnership to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions &amp recommendations to improve Family medicine.In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, educational institutes and baseball club. Within the limit of this essay, I would like to propose some solutions and recommendations as follows a. increase the quantity of Family physicians with supernumeraryly trained General practitioners and using the retired medical doctors The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower cost (Rakel, 2011). In the get together States, a 20% increase in the number of primary care physicians is associated with a 5% decrease in mortality (40 less expiration per 100,000 population), but the benefit is even greater if the primary care physician is a family physician.Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, the higher the primary care physician-to-popul ation ratio, the better most health outcomes are (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), adjusted mortality will bring down about 5% in chronic diseases (Gulliford 2002).The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in developed medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems acute or chronic diseases without complications or no need to transfer to Specialty hospitals (Dang Van Phuoc, 2012). To compensate the continuing decline of the number of students entering primary care as a park trend in the world (Bodenheimer et al. 2009) and inadequacy of graduated general practitioners, a polity to support general practitioners and retired medical doctors to practice as Family physicians such as spare procreation about Family medicine, financial supports, motivatorshould be prepared and implemented. Rather than other countries where Family physicians usually work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This advantage allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician compliance training programs Quality of care and the lack of medical training are two major concerns of Family physicians. compensatetually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care.To improve their quality of care in accordance with global health principles, proposed solution is to build emerging curricula of family practice residency programs to envisioning family physicians as horizontal speci alists who can deal with the large majority of patients needs on a continuing basis (Rakel, 2011) and envisioning this role as consolidation humanized care with a high level of competence in scientific medicine. In contrast to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine by dint of formal training in inhibit interpersonal skills and in the behavioral and social sciences.Implementation of this role, however, requires reorganization in spite of appearance the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is difficult if not impossible within the normative organizational structures of highly narrow down medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be combined into General practitioner and Family physicians training curriculum for organism sure about the quality of primary care as follows (i) Clerkship adding cognition of result global disease in the world such as tuberculosis, malaria, Preventive care vaccination improving skills such as clinical making decision, communication. ii) Orientation Adding knowledge of new  emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/acquired immune deficiency syndrome (iii) Residents adding knowledge of prenatal care,  neonatal care,  chronic care, mental health care, adolescent care  Emergency care in fortuity improving skills such as doing research and practice Emergency care in disaster, Behavioral care after disaster, Kangoroos program, Obs-Gyn care program building up the kin center care with raise- WIN theory for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be strengthened for teaching, managing, doing resea rch to promote the concept relationship center care through many activities * Establish Continue Medical Education, Patients clubs. * Build the bridgework or integrate the teaching contents  in Family medicine  with the other specialties like Pediatrics, Traditional Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). Communication through detainet/ ikon conference and Electronic medical The WHO 2008 report emphasizes the appropriate use of information and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners computers or for one paginate photocopying from the book Patient Education (Murtagh J 2008). Besides the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient happiness ( dividing line tin et al. , 2004a).Overall, people indirect request their primary care doctor to meet five basic criteria to be their insurance plan, to be in a location that is convenient, to be able to schedule an appointment within a sensible period of time, to have good communication skills, and to have a level-headed amount of experience in practice. They especially want a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care (Stock cornerstone et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) building an incentive plan and financial supporting policy to Family physicians, especially whom working in remote and rural areas The effectiveness of this impersonate had been proved in many countries, particularly in Thailand and Malaysia where he althcare conditions are fairly similar to Vietnam.Contrarily, the recent P4P (Pay for Performance) policy of Thailands of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is considered as a main cause track the Family physicians moving to major cities. With relation between income and ecstasy, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income procedural specialties, such as Obs Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. mendeleviums in these specialties and those in internal medicine were more liable(predicate) than family physicians to be dissatisfied with their races.Among the specialty areas most satisfying was geriatrics. Because the population older than 65 years old in U. S. has bivalent since 1960 and will double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice must be communicated to students before they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with their careers are more likely to provide better health care than dissatisfied ones. Physician satisfaction is associated with quality of care, particularly as calculated by patient satisfaction.The strongest factors associated with physician satisfaction are not personal income, but rather the ability to provide high-quality care to patients. Physicians are most satisfied with their practice when they can have an ongoing relationship with their patients, the granting immunity to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landon&amp colleagues (2003) found that rather than declining income, the strongest predict or of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, control their time with patients, and the freedom to provide high-quality care. ii) Compulsorily assigning General practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) upward(a) facilitates of local level hospitals/clinics, enforcing the lower level hospitals to implement modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the reputation of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community.Even a fter the specialty is formally hold by institutionalized medicine, family physicians have experient a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine to Family medicine first, the field was ignored second, it was actively opposed and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, revise the residency training programs, improve its reputation in the society .. etc.In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote founding to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine Regardless of how computer lite rate we are or how high our technology or whether the setting is urban or rural, good medical care in the future will continue to depend on patient care provided by a concerned and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics and by compassion and communication, and not by capitation. Good medical care in the future will depend, as it does now and always has, on the quality of our interaction with the patient Dr Robert Rakel 14th WONCA World Conference) REFERENCES 1. Alain J. 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