History of Family Medicine in Malaysia

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e coverBy: Dr Zaiton Ahmad & Prof Kwa Siew Kim

Family Medicine is gaining more attention and importance both as a medical speciality and service provider. The uniqueness of this speciality is that it transcends all disciplines and is not delineated by the patients’ age, sex or nature of their complaints. The government policy on “equity and accessibility” has also made this area of expertise more in demand.   This awareness is also due to the need of a holistic and integrated approach to patients’ care especially in the community. The public especially in the community now demand higher quality of care at the primary care level.

In Malaysia, Family Medicine is relatively new to the Malaysian health system. It started in the late 1980s when there was a need to change and expand the paradigm in primary care. Hence there was a need for specialised medical care at the primary care level. The training of Family Medicine involves all aspects of clinical care, preventive health care, managerial skills and continuing education. It has now been recognised as a specialty in its own right in the developed countries. Realising the country’s needs, the public universities have initiated the FMS through its Masters programme.

UM had started the Master of Family Medicine Programme in the year 1989 with two candidates. The next batch of FMS graduated from UKM and UM in 1997, making a total of ten FMSs in the MOH. The three universities i.e. UKM, UM with Universiti Sains Malaysia (USM) held their first conjoint examination in 2002. The number of contact hours for this attachment in most universities is at same par with the other disciplines such as Surgery, Obstetrics and Gynaecology, Paediatrics and Internal Medicine.  Since then more than 250 FMSs have graduated from the three universities. More than three quarters of the FMS is working with the MOH while the others are in the both public and private universities as well as in private practice.

Currently less than 15% of all the health clinics have FMSs. This is   less in number than what the three public universities (UKM, UM, USM) could produce. Other universities e.g. Universiti Technology MARA (UiTM) just started their own program  while University Putra Malaysia (UPM) and International Islamic University Malaysia (IIUM) will start their own Masters of Family Medicine programme in order to increase the number of graduates. This is in line with the MOH’s target to allocate FMS in all the health clinics throughout Malaysia. Since the presence of FMS in the country, the scope and services offered in public primary care clinics has been augmented. As a consequence, the FMS felt there was a need for them to be represented as in other specialties. With the founding of the association, members of the organization will also have financial standing; issues related to the speciality will also be addressed appropriately.

Hence, the establishment of the FMSA was initiated during the FMSA Conference in Cinta Sayang Resort Kedah in year 2000. A protem committee was formed headed by Dr Zaiton Ahmad. Subsequently Dr Khairi Mohd Taib was nominated as the first FMSA president in 2003.Since then, FMSA has gained strength in terms of membership not only from graduates of Family Medicine but also from the MRCGP and FRACGP.

As gate keepers in the health system, the Family Medicine speciality has various challenges both currently and in the future. These challenges are due to the changing socio-economic factors, lifestyles and disease patterns. Issues on ageing population, communicable and non-communicable diseases as well as mental health are among the current concerns.

In conclusion, the public expects doctors to be professional, have good communication skills and to be caring and compassionate.  Since primary care is the most accessible and utilized form of medical and health care, FMSs have an important and leading role in maintaining the health of individuals, their families and the population.