The changing role of the family practitioner in the Caribbean

ABSTRACT

Family medicine has its origin in 15th Century England, when apothecaries filled the gaps in British health care of that time. The discipline has had a checked history and in the West Indies in 1984 the poor health care situation resulted in the University of London establishing a college, The University College of the West Indies, to produce general practitioners to work in the islands of the Caribbean. Over the past 50 years the role of family practitioner has changed to the extent that the same educational institution, now the Faculty of Medical Sciences of the University of the West Indies, produces family doctors with post graduate training equal to that in all of its other post graduate programmes. Over 40 percent of Family Medicine in the Caribbean today must be preventive in one or more of its many forms. The role of educating and counselling in an ever more influential market society is an essential preventive function, as is the need for screening and case findings. The challenge is to view every encounter with the patient as an opportunity for some necessary screening or prevention. In addition there is the need for management skills, not only to facilitate the best use of increasingly complex health services, but in many cases to protect the patient from these. Essential to the care of patients with urgent problems, those with chronic diseases and those with psychological and behavioural problems, is the mystique of the doctor-patient relationship. This powerful tool is built on understanding and trust, it facilitates communication, motivation and partnership in health care. It is the core of modern family medicine where ethical issues and clinical decision are worked out jointly by doctor and patient. This changing role of the family physician occurs in response to the availability of specialists in both primary and secondary care. The future will be shaped by the family physicians who are motivated to record and analyze their observations and experiences in this unique speciality. Research in family medicine is essential for further understanding and definition of the discipline, and only the family physician can set the scene for this.(AU)