The Way Forward of Family Medicine in Malaysia

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Sri WahyuBy: Dr Sri Wahyu Taher

It has been more than 10 years since the inception of the Family Medicine specialty. Since then the specialty has expanded enormously yet there is still room for further improvement. Family Medicine is a diverse specialty thus encroaching on wide areas of medicine pertaining to primary care. Over the years many FMS have received training in various areas of interests either overseas or locally namely in various areas such as Non Communicable Disease, Substance Abuse, Community Psychiatry, Community Paediatrics and others. The concept of ‘from womb to tomb’ provision of care has provided a wide opportunity for expansion. Its relevance has becoming increasingly significant since disease emergence has made a complicated turn in our society. Primary care is now the focus of disease control more so when intervention and promotion play vital roles in disease prevention. The concept of ‘prevention is better than cure’ i is certainly true in primary care and is spread across the board.

Clearly there are other areas where FMSs could have an impact in, i.e. by building up areas of interests. The fraternity must continuously seek and venture into areas that may seem to be less important but in actual fact are practical and needed. Areas like Travel Medicine, Rehabilitation, Aesthetic Medicine, E-Medicine and Complementary Medicine may sound irrelevant towards promoting a healthy society nevertheless these are the areas that is now growing in popularity in other developed countries. Therefore FMS should keep on striving and venturing into these relatively new areas for career development and opportunities in empowering our society into becoming healthier individuals. These advancements must not overshadow the existing areas of interests and the primary role of FMSs as a Primary Care Physician in delivering a holistic and comprehensive care for the society as a whole.

Being a specialist should not deter FMSs from becoming a leader with visionary aims of the future. A good leadership steered by credible FMSs with wide experience is needed in this current situation where primary care is continuously challenged. Leadership is not bestowed on individual naturally. It has to be instilled very early in the career. Personality and open mindedness is part of a good leadership. The training to become a leader has to start during the gazettement period if not during the specialty training itself. Therefore university trainers and lecturers are responsible in leadership training during the Master of Family Medicine Programme. Senior FMSs who are responsible in gazetting the junior FMS must direct and lead the young FMS into become leaders in the fraternity. Health clinics need good leaders to navigate the organization and all clinical programs. FMS are in the position to fulfil the need of a good conscientious leader in building up the health clinics into a centre of excellence in all aspect of care in the community. FMS have to be in the forefront of a health clinic in making the organization a competent and comprehensive centre in line with the needs of the community and the aspiration of the stake holders. FMS must always look forward and face up difficulties even though sometimes it may seem to be hopeless. A leader should not be deterred by the obstacles and must continuously be positive in facing these challenges for the betterment of the fraternity and the people we serve.

FMS as a renowned leader in the community providing clinical care must be prepared to be involved in research, scientific paper writing and most importantly to act as an advocator in policy making. Not many FMS are interested in writing or doing research.  However, these are some of the characteristics of a good leader of an organization. FMS have to be the primary provider of scientific evidence pertaining to primary care and interests in research must be a catalyst to new development. There are so many researches that a FMS can take up. It can also be collaboration with the counterparts in the secondary and tertiary centres. FMS must be bold enough to be the initiator in all research especially issues or hypothesis involving the community. In this way, FMS will always be seen as a specialist that has a lot of ideas, resourceful and in the frontier of new findings amidst the negative allegations spread around by other fraternity. FMS has every opportunity to do research because the family medicine discipline opens to a broad and diverse area of research. Primary care is a broad discipline and it enables FMS to lead research in all aspect of care because it is a comprehensive and holistic specialty.

Apart from research, FMS could also contribute as a writer. Writing can be in many forms. FMS can contribute in a scientific write up pertaining to a specific subject or findings like in a scientific research. FMS can also write in a scientific section as a contributor in a stated chapter of a particular issue in a publication. FMS can contribute as a writer in any of the chapter in a given subject, protocol or policies publish by Ministry Of Health. One of the examples is an invitation to become one of the writers in CPG Development Committee. It is really a great honour for the Family Medicine fraternity as FMS get invited to contribute in any of the Clinical Practice Guideline development by the Health Technology Assessment. In the past FMS has contributed in the development of various MOH CPGs and it is a pride of the fraternity. This achievement must continue and FMS must strive to achieve further success in order to uphold its reputation. However for other FMS who do not have the opportunity to write in a scientific paper they can also make a reputation in public writings example in magazines, newspaper or any articles that provide clinical and relevant information to the public so that they are guided to make healthy life choices. It may seem a small and less important contribution but in actual fact an essential provision of information coming from a credible and reliable writer especially if it touches the heart of the people and help them to lead a healthy life style thus disease prevention in the future.

FMS as a primary care physician must play a role in integrating primary care providers in MOH and private sector. There is a lot to share with the primary care doctors in the private sector. Family Medicine fraternity has been a bench mark in primary care services in Malaysia. Primary care providers in the MOH complement services provided by the private doctors in primary care. Likewise primary care doctors in private sector are to reflect on the present provision of care given by the FMS to improve their own service provision. However the relationship has to be strengthened in order to lift up the primary care services in Malaysia to a level of international recognition. Additionally, the strength will prepare the fraternity for future challenges in reaction to advancement.

FMS play a very important role in giving feedback and input to the Family Medicine training centres in universities and other agencies namely the AFPM. This responsibility is entrusted to the FMS because the training background gave us the experience and exposure to deliver services that meet the needs of the community in a holistic manner. Inputs from the FMS are important to improve the training curriculum and prepare Family Medicine trainees before passing the examination.  Curriculum must be in line with the demands of contemporary primary care provision of MOH. The universities have to ensure quality and competency in their candidates and feedback from FMS are needed to guide them to form a curriculum that is relevant and significantly adequate to face continued escalating demands.

In addition to the above discussion, involvement in NGO activities is an area FMS must aspire. FMS are in the best position to contribute and play a role in leading the NGO’s activities because we are specialists in the community and there are many NGOs that help the community in various ways. FMS are diverse specialists with multi skilled characteristics thus capable of steering the NGO. For example, involvement in NGO that fights for the right of abused individuals, people living with HIV, diabetes advocator and hospice care are just a few examples FMS can make an impact in helping out groups of society that has been given less attention and priority. This philanthropic relationship and involvement will definitely benefit the organization especially in planning for their community services.