Throughout the world, governments have an interest in the health of their people. At the same time, whatever their level of resources and development, all governments recognize that healthcare costs must be constrained and they have to seek ways of ensuring best possible health gain for each unit of health expenditure. This becomes all the more important in countries like Pakistan where resources are scarce and hence service priorities must be narrowly focused.
Globally over-specialization of physicians has fragmented and created barriers to the provision of essential care to individuals. Health systems need physicians trained to meet a broad range of community health needs. This makes the role of physician integral to an efficient healthcare delivery system. Many developing countries have curtailed their high mortality rates just by focusing on the component of healthcare delivery.
Family physicians are doctors able to take care of whole families. These individuals trained in the area of family medicine, adult, pediatric medicine and women's healthcare and treat 90 percent of a family's medical needs. Family physicians ensure delivery of comprehensive, continuous, coordinated and personalized healthcare.
Statistics indicate that in Pakistan, the demand for family practitioners is maximal for treatment of illnesses of short duration i.e. 3 days whereas in case of illnesses with duration longer than 3 days, specialists are mainly consulted. Keeping in view the fact that diseases such as diarrhea/dysentery, respiratory tract infections, tuberculosis, typhoid, malaria etc. (which can effectively be treated by family physicians) are amongst the most common causes of deaths in Pakistan, the role of these practitioners becomes all the more profound.
Specialist services, both diagnostic and therapeutic in comparison with those of primary care physicians are more expensive. They are more effective only when the specialist's expertise is appropriate to the patient's needs and when the patient presents the right natural history of his or her disease.
Self-referral by patients, unaided by a primary care provider (family practitioners) is thus often ineffective for it may occur too early in the course of the illness or the initial choice of specialist may be inappropriate requiring further referral. Access to specialists should in general be through referral by primary care providers only. Since the referral decision is fairly technical, the better trained the primary care provider, the better the initial care provided and the more efficient the referral undertaken.
However, until and unless health systems invest in maximally trained primary care providers, who can efficiently and comprehensively deal with the patients' needs, patients shall continue to self refer, thus overloading secondary and tertiary care facilities with problems that can easily be handled cost efficiently at the primary care level. At present in Pakistan very few family practitioners have the requisite training and post-graduate diploma in family medicine. Lack of postgraduate training facilities in family medicine being the most probable cause. Educational bodies in Pakistan should take the responsibility of creating better opportunities for postgraduate training in family medicine, thereby ensuring access to better quality, cost-efficient healthcare.
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