"More than ever health systems are facing major challenges to their sustainability and to the greater goal of providing care to all citizens according to their needs. The cumulative situation of an ageing population, a greater burden of chronic diseases and lack of definition regarding the organisation of health systems have not allowed us to find a way to achieve the stability that would be essential for health services to respond robustly, with quality and safety, to the problems that lead people to seek medical help. Health systems are complex organisms that need a strong heart - General Practice and Family Medicine!
With the slogan "Family Doctors - the Heart of Healthcare" we highlight World Family Doctor Day 2023. WONCA, the World Organisation of Family Doctors celebrates this day with initiatives in every country, in every community, in the Primary Care Units where families meet their doctor daily. Family medicine creates a unique bond of trust between doctor and patient, between Primary Care teams and families. This strong heart of a complex organism is a guarantee for more and better health and also a factor of social cohesion.
General Practice and Family Medicine generates in health systems a virtuous circle of care from birth to the end of the human being, in a continuum of health promotion, disease prevention and management of acute and chronic health problems, from the simplest initial stages to the most complex and advanced.
And to the central role of Family Doctors in health care systems, WONCA associates to this year's ephemeris four pillars on which the practice of General Practice and Family Medicine is based, leading to the health and well being of the population.
They are four subsidiary "organs" of the heart of health care that, as Family Doctors we incorporate into our clinical practice:
1. Continuity of Care
We create a strong bond with our patients, individuals and families, whom we accompany throughout their lives without ever discharging them. At a certain point, the formal intimacy that makes us feel part of those families is inevitable. Consultations can be moments of health surveillance and opportunities to promote healthy lifestyles and prevent illness. We issue the medical certificate for the driving licence to the young people we have seen being born. We are always there and we are the ones who hear the anxiety of the first job and the emotions of the birth of the first baby. Often appointments are unexpected occasions to assess a sudden problem - an acute illness, a dilemma about a treatment, an anxiety factor in family life or a stranger symptom for which there is no explanation. And we do explain. We see our patients grow older by helping them to stay healthy and active. But there is also room, and necessarily plenty of it, to address a chronic illness that can often be associated with other pathologies in an often complex set of multimorbidities. We are always present. So much so that our patients tell us - "it even feels like you live in our house". Scientific evidence shows the importance of continuity of care and its association with better health outcomes and lower overall mortality rates[1]. Health systems should give priority to organisational models with continuity of care.
2. Patient-Centred Care
Medical practice in all specialties should be based on this pillar. However it is unanimously recognised that General Practice and Family Medicine is the paradigm of patient centred care. In fact in our practice and following the Hippocratic principle propounded by Sir William Osler "it is more important to know the person who has the disease than to know the disease the patient has". And the health system should also be organised on this assumption of clinical practice - centring care on people and not on illnesses. From the pillar of continuity stems the relational strengthening between us and our patients. Every day, in the sacred space of each appointment, we use genuine empathy as a diagnostic tool, in an integrated bio-psychosocial approach, and as the main therapeutic element with extreme care in the dosage applied and administration times. This idea was launched by Michael Balint[2] when he preconised that «the doctor must learn to use himself as "medicine" with the same skill that the surgeon demonstrates in the use of his scalpel, the clinician in the use of his stethoscope, and the radiologist in the application of his "lamps"». In this unshakeable alliance, we are a haven for the suffering person and providers for our patients. Invariably, at the end of a consultation, we hear, as we say goodbye to our patients, that "just by coming here to talk to you, I already feel better".
3. Care Integration
In the image conferred by the motto of the World Family Doctor Day, we are the heart of healthcare. And the third pillar with which WONCA marks the occasion this year is directly linked to the idea that Primary Care is the core of the health care system and the first point of contact. Family medicine is the co-ordinating centre of the whole system, and we are regarded in the literature as the doctors who manage the integrated care of individual patients and their families[3]. It is a team effort which we coordinate, and which the patient associates with the image of an orchestra - "doctor, my health problems have been accompanied by good soloists from various musical instruments, but I lack a conductor, and that is why I come to you". And the coordination of care includes the integration of the various medical specialities involved and other fundamental areas in this process - nursing, social work, psychology, nutrition and physiotherapy. This multi-professional teamwork promotes the integration of care and breaks down the artificial barriers between traditionally distant levels of provision. Coordinated collaboration between Primary Care health units, Hospitals, Continued Care units and other types of networked health units meets the real health needs of the population and strengthens the health system.
4. Community Involvement
We cannot assume ourselves as the heart of healthcare without an effective connection to the community. Our role as the coordinating core of care integration presupposes active collaboration with the population. Shared clinical and health governance with the citizens must go hand in hand with the same logic in the provision of care. This model of co-production of health is proposed by the WHO European Region for a sustainable future of health systems[4]. The full participation of the population in their health care pathways with effective empowerment for self-care and improved health literacy follows from this model. In our patient-centred approach we have to involve the community, both in diagnosis and when establishing a care plan. We are in a privileged position to listen to the vital signs of the community and understand how they impact on the health of the population. We must identify the social determinants of health as a key element in the biopsychosocial assessment of our patients and consider them when outlining a comprehensive treatment of the diagnosed problems. Community resources must be mobilised for a comprehensive care plan that addresses the different dimensions of the disease process and results in the improvement of the physical, mental and social well-being of our patients.
On World Family Doctor Day we celebrate General Practice and Family Medicine, this year with a slogan which refers to our central role in the health care system. However, we do not work alone, and it is in teamwork with other medical specialties and health professions, involving the resources of the community, and working in collaboration with all sectors of society, that we can truly improve the well being of the population. The health of the families who trust us has been and always will be our primum movens.
General Practice and Family Medicine has a future and in the current context of digital transformation of Health, it assumes a vanguard role in the technological development of Medicine and is at the same time a stronghold which guarantees the hypocritical principles of our profession, safeguarding the humanistic dimension of the doctor-patient relationship. We have the duty to transmit these values to the new generations and also to be the heart of teaching in medical schools.
Happy World Family Doctor Day!"
João Sequeira Carlos
[1] Pereira Gray DJ, Sidaway-Lee K, White E, et al. Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018;8: e021161.
[2] Balint M. The doctor, his patient and the illness. London: Churchill Livingstone; 1993.
[3] Primary care as a hub of coordination: networking within the community and with outside partners. World Health Report – World Health Organization, 2008.
[4] Kickbusch, Ilona & Gleicher, David. Governance for health in the 21st century. World Health Organization – Regional Office for Europe, 2012.