Family medicine: a brief review of its history and concepts and its relevance to Pakistan

Inmost countries of the world some form of family medicine is being practiced by members of the medical profession. In over fifty countries distinct practitioners of this form of medicine are recognized and in some countries formal designation as specialists is accorded to them. In certain countries the physicians are called family practitioners and in others they are called general practitioners. Both terms are correct as these physicians have broad-based clinical skills (generalists) and also take care of the families. In Pakistan health care is usually available only to those who can afford it. A large segment of population consists of people struggling to survive, who also carry a disproportionately heavy load of illness (L. Lee. Family Medicine; Some concepts, unpublished data, 1987). Furthermore, the health care system lacks a solid base of primary care physicians, both in number of practitioners in areas of greatest need and the quality of care provided. Competition in primary care private sector between family practitioners and specialists frequently leads to ineffective or inefficient utilization of scarce resources. Specialists with hospital based experience may tend to over-utilize the diagnostic and treatment modalities when dealing with first contact presentations, while general practitioners with inadequate training/ex­perience are in general poorly prepared to provide scientific, comprehensive and flexible care to the com­munity (B. Mi, R.W. Zuberi and B. Inam, unpublished data, 1990). The lack of referral facilities, in the case of the latter, compounds the issue. The broad-based training in family medicine, the high quality ambulatory clinical care and the strong community medicine base may fulfil many varied func­tions and meet the obvious deficiency in the health manpower training and development in Pakistan. It may also be a major solution to face the daunting challenge of health for all (A.H. Jiwani. The question of residency training in primary care unpublished data 1987)

Center-based prevalence of anxiety and depression in women of the northern areas of Pakistan

Objective: To estimate the prevalence of anxiety and depression in women of the Northern areas. Methods: A cross-sectional center-based study was conducted at Singal Medical Center (SNIC), Gilgit, in the Northern Areas of Pakistan, using the Hospital Anxiety and Depression Scale (HADS). Results: One hundred and twenty women, between the ages of 16 and 60, attended the SMC over a two month period and were included in the study. Using HADS, it was found that 50% of the women had anxiety and/or depression; 25% suffered only from anxiety, 8% from depression and 17% had features of both. Conclusion: This study supports the previous studies of stress in remote areas and also contradicts the belief that people who live in the remote rural areas lead stress-free lives or have low rates of psvchiatric morbidit

Faculty and patient evaluations of radiology residents\u27 communication and interpersonal skills

Objective: To assess communication and interpersonal skills (CIS) of radiology residents through faculty and standardised patients (SP). Methods: In this day-long objective structured clinical examination (OSCE) in January 2009, 42 radiology residents took part at six stations in Karachi, each with a standardised patient and a faculty evaluator. Each encounter lasted 15 minutes followed by independent assessments of the residents by both the evaluators. Results: Based on rating-scale evaluations, all cases had satisfactory internal consistency (Cronbach\\u27s alpha 0.6 to 0.9). The alpha values were comparatively diminutive against the checklist scores. Correlation among faculty was 0.6 (p Conclusion: Both checklists and rating scales can serve as satisfactory assessment tools for communication and interpersonal skills using objective structured and clinical examination with the assistance of faculty and standardised patients

The diploma in family medicine examination; a scientific exercise

The Diploma in Family Medicine (DFM) Examination Is a new certification offered by the College of Physicians and Surgeons of Pakistan, and its Department of Medical Education designed a scientific examination. First, the Expert Advisory Committee for Family Medicine was formed, relevant training objectives Were determined, a training programme to achieve the objectives was designed and a valid syllabus was chosen. Then the examination was designed, where the candidates must pass the objective theory papers before taking the clinical examination. The clinical examination consisted of an Objective Structured Clinical Examination (OSCE) and traditional case presentations. The candidates had to pass each of the components, and attain an overall aggregate of 60%. In the first six examinations, 752 candidates sat for the theory examinations, 332(44.14%) were eligible for the clinical examination, and 170 (23%) passed. If 60% marks obtained in case presentations is taken as the gold standard which is the current CPSP policy and compared to OSCE marks, then 75% marks in OSCE had a sensitivity of 67% and a specificity of 79

Family medicine postgraduate training in Pakistan

There is no organized system of postgraduate training for family medicine or general practice in Pakistan. This paper describes the status of primary health care delivery in Pakistan and the growth of family medicine throughout the world. It stresses the need for organized postgraduate training relevant to the needs of primary health care in Pakistan and describes efforts currently under-way in this regard at the Aga Khan University Medical Center (AKUMC) in collaboration with the College of Physicians and Surgeons of Pakista

Professionalism in medical students at a private medical college in Karachi, Pakistan

Objective: To determine levels of professionalism in undergraduate medical students at a private medical college and assess how changes emerge during their training. Methods: The study was conducted at Aga Khan University, a tertiary care teaching hospital, during November and December 2011. Freshmen, Year 3 and Year 5 students were requested to fill out a questionnaire. It was designed to assess the participants\\u27 levels of professionalism and how they perceived the professional environment around them by incorporating previously described scales. The questionnaire was re-validated on a random sample of practising clinicians at the same hospital. SPSS 17 was used for statistical analysis. Results: The study sample comprised 204 participants. The mean score for level of individual professionalism was 7.72±3.43. Only 13 (6.4%) students had a score one standard deviation above the faculty mean. About 24 (11.8%) were one standard deviation and 35 (17.2%) were 2 standard deviations below the faculty mean. The remaining 130 (63.7%) were \u3e2 standard deviations below the faculty mean. Considering the level of education, the mean score for level of professionalism was 8.00±3.39 for freshmen, 6.85±3.41 for year 3 students, and 8.40±3.34 for year 5 students. Conclusion: The currently employed teaching practices inculcating the values of professionalism in medical students are serving as a buffer to maintain the pre-training levels of professionalism from declining

Late weaning: the most significant risk factor in the development of iron deficiency anaemia at 1-2 years of age

Background: The global prevalence of iron deficiency anaemia in young children is quite high and children between the ages of 1–2 years are at maximum risk. The complications of anaemia are well known, and side effects may go unnoticed and may have an adverse effect on child’s life. Therefore, prevention of anaemia becomes enormously important, and the need to look for parameters and predisposing factors that may lead to iron deficiency anaemia in small children is imperative. This study was designed to determine the association of iron deficiency anaemia with late weaning in 1–2 years of children. Method: A case control study was conducted from July 1993–July 1995, at the Community Health Centre (CHC), of the Aga Khan University Hospital, at Karachi, Pakistan. The study included 50 cases and 100 controls. A questionnaire was filled by mothers after taking consent. Data was analyzed by chi-square, t-tests, bivariate analysis and multiple logistic regression. Results: Through bivariate analyses, late weaning, family income, mother’s education, the numbers of pregnancies, live births and living children, were found to be statistically significant. These variables were run through a multiple logistic regression model and late weaning was found to be the most significant. 60% of cases and 9% of controls were weaned late (pp Conclusion: Among all the variables studied, late weaning was the most important predictor of iron deficiency anaemia in 1–2 years of age

The relationship of socio-demographic factors with Iron Deficiency Anaemia in children of 1-2 years of age

Objective: To investigate associations between different socio-demographic factors with iron deficiency anaemia in Pakistani children of 1-2 years of age. Methodology: A case control study, with 50 cases and 100 controls, was conducted at the Community Health Centre, an outpatient clinic of the Aga Khan University, Karachi, Pakistan, between July 1993 - July 1995. Informed consent was taken from mothers for their children’s blood tests and a questionnaire was administered to them. The data was analyzed using chi-square, t-tests and logistic regression. Results: The numbers of pregnancies, live births and living children were more among cases than controls but the differences were not statistically significant. Although father’s education did not show a significant association (OR 1.35, 95% Cl 0.22 - 8.33), maternal education was significantly associated with the children’s anaemic status (OR 3.55, 95% Cl 1.40 - 9.02). The difference in monthly incomes between families of cases and controls was the most significant variable among all those studied (p-value 0.006). Conclusion: This study showed that while lack of maternal education and low monthly family incomes are both significantly associated with the development of childhood anaemia, low monthly income is most significan