Introducing the concept of Family Doctor in Malaysia

It is not easy to introduce something like the UK National Health Service system in Malaysia especially with the current economic climate however, to introduce the concept of a "Family Doctor" is not impossible. Most of us have a family doctor whether we call it that or not. The doctor that we often go to whenever we have some medical complaints is in essence our family doctor. When I was growing up, I had a family doctor who was also a neighbor so most of us will do.

The role of a family doctor towards the patient starts even at birth. After 6 - 8 weeks of giving birth, all mothers should go for a post-natal check up and it is also around this time that the baby will be due for another immunization schedule. At this check up, the family doctor will do a post-natal check up for mom and 8-week check for baby. 

The family doctor is also the one that mom (and/or dad) will go to if baby has any medical problems or is unwell. Otherwise mom and dad will bring the baby for routine immunization as well as developmental check up until the age of 3 and half. 

So, the family doctor gets to know a person from birth and looks after the whole family for any medical or indeed social issues. Imagine a child who has been seeing his/her family doctor with the parents and goes on to reach adolescent age. Some families are fortunate to be open and informative to their children about adolescent issues but sometimes adolescent may want to speak to someone professional, non-judgmental and a neutral third party. The child / adolescent may have acne problems, issues of self-esteem, peer pressure, or sensitive issues such as relationships, sexuality, body image, sexual abuse or bullying. The parents may want to bring the child to see someone who can educate and give further information with regards to these issues or to handle sensitive issues and to refer the family to appropriate services. The family doctor is a good place to start. Hence, part of the training of a family doctor is in communication, being non-judgmental, handling sensitive cases and to be the neutral / impartial person as well to coordinate patient care by referring to appropriate services. 

If a person is going through a difficult time in life or stressed out due to marital issues / work environment / bereavement or perhaps suffering from depression or some other mental illness, the family doctor has a role in listening, advising, making a diagnosis and if required to start treatment or refer to another specialty. The family doctor can also offer advice and emotional support for carers as well as referral to appropriate services e.g. counseling, hospice / respite care. 

Couples who are wanting to become pregnant may want to go for preconception counseling and the family doctor whom may have known them for years may be the first medical personnel that the couple would approach for advice. Older patients may require cardiovascular screening and management of chronic diseases such as diabetes and high blood pressure. Chronic disease management requires a continuity of care by a family doctor who knows the patient's medical background and pattern of illness in order to achieve good control. The family doctor gives education to the patient, encouragement for lifestyle change as well as medication monitoring. 

Therefore, in a day there is never a dull moment as a family doctor because of the variety in the cases seen. The cases may range from a simple sore throat due to viral infection up to serious conditions such as a person coming with chest pain suspected of a heart attack. The family doctor's challenge is to identify patient's verbal and non-verbal cues, to make a provisional diagnosis sometimes based on non-specific or early symptoms and most importantly, in decision making. Making a decision about treatment is an important skill for a family doctor because a family doctor works in a clinic and there is no observation ward or 24-hour monitoring to observe the progression of the disease. 

Hence, in countries like this one where there is not yet a system that dictates patients to register with one family doctor, patients can still understand the concept of a family doctor and how having a family doctor may improve their health quality.