Principles of Family Medicine and Aardram : Kerala Model

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Dr. Serin Kuriakose

Mission AARDRAM aims at creating a "People Friendly" Health Delivery System in the state. The approach will be need-based and aims at treating every patient with ‘dignity'. Through state of the art investigation and intervention protocols, it envisages transforming all Primary Health Centers into Family Health Centres as a first-level Health delivery point.

The objectives of Mission Aardram are:

• Transform Primary health centers to Family Health Centres
• Avail the best service of the best doctors and paramedical staff (Quality of Service)
• Reform out-patient management procedures with state-of-the-art facilities
• Facilitate with hygienic and spacious wards, rooms, beds, and toilets
• Avail Life Saving Medicines from the hospital concerned on moderate rates

Principles of Family Medicine & Aardram: -

1. Family physicians are committed to the person rather than to a particular body of knowledge, group of diseases, or special disease. In simpler terms, a Family Physician adopts a holistic approach while dealing with patients, thereby addressing the patients physical, mental and emotional health while taking social factors into consideration.

2. The family physician seeks to understand the context of the illness. A Family Physician is keen to know the impact each illness has on the individual, family and the community. By implementing Aardram, Government is foreseeing a future, where a doctor can explore and treat all aspects of one’s health from the organ level to the individual, family and community levels. The current doctor-patient ratio is a huge setback to this idea. But once, more Family Physicians are posted in these FHCs and all other components of Aardram are in place, this principle of Family Medicine also will fall into place. In Kerala,we have a well established health care delivery system comprising of Public Health Nurses, Junior / Health Inspectors / ASHA and other community health workers .These community health workers aid the Family physician in the FHC to understand more easily about the social and cultural aspect of illness , even before patients come to the health facility.

3. The family physician sees every contact with his or her patients as an opportunity for prevention of disease or promotion of health Aardram mission envisages to ensure the promotion of health at every level – local groups for health awareness, aarogyasena, sub center, Family Health center, etc. Rather than just seeing the patient at the hospital / FHC level, a family physician also gets the opportunity to promote health of the community by conducting health talks, awareness classes and distribution of pamphlets and posters.

4. The family physician views his or her practice as a “population at risk”. The aim of a Family physician is to maintain the health of all the people in the community. When a patient is treated at FHC, a doctor never becomes satisfied with the treatment of that particular patient alone, rather he /she will be interested to assess the risk, identify the key issues and finding the measures to rectify the issues. He also keeps a check on those at risk of developing a disease and those exposed to certain risk factors.

In the proposed/being implemented Aardram model, the Doctor has much more accessibility to the public/population through the network of community health workers.

5. The family physician sees himself or herself as part of a community-wide network of supportive and health-care agencies. Aardram model is incomplete without the involvement of a community-wide network. A family physician can contribute his maximum potential only with the help of community-wide networks. Apart from healthcare workers, all possible volunteers and agencies are included in this network in Aardram Mission

6. Ideally, the family physician should share the same habitat as their patients. This is one of the toughest parts of being a Family Physician especially in the government setup. Even before the implementation of Aardram a Doc at the PHC/ FHC is supposed to stay near the community where he/she is appointed. Sharing the same habitat helps the doctor to have a better understanding of the cultural /behavioural/ social needs and culture of the society in a better way.

7. The family physician sees patients in their homes. Home visits form an integral part of a Family physician’s work. But in the current scenario, with the existing man-power and infrastructure, Aardram doesn’t incorporate home care services. Instead a secondary care palliative system is made available for patients who require palliative care as the situation warrants.

8. The family physician attaches importance to the subjective aspects of medicine Listening to the patient and their bystanders and well-wishers is an integral part of Aardram. A family doctor is empathetic to the patients as well as his family. In the Aardram model, a greater emphasis is given to this and a trained nurse is assigned to address the issues at the entry point.

9. The family physician is a manager of resources. This is one of the key roles of a Family Physician. Being the team leader a Medical officer at the FHC is supposed to be the best manager of the resources. Especially in a country like India, where there is a serious scarcity of resources, a good part lies in the careful management of resources. Kerala is no. 1 in the health scenario of India. It is no exaggeration when we say that Kerala’s health status is almost at par with that of developed economies. In the Aardram model, FHCs are being implemented across Kerala in a stepwise manner. The government is trying to make this Mission as productive as it can be

Yet there is a big misconception that Aardram is mainly focused on extending the outpatient timings alone. One of the major flaws in the current healthcare system is the doctor: population ratio or doctor-patient ratio at the primary contact points. Unnecessary referrals and lack of competency due to unavailability of a multi-skilled family physician in a primary care set-up lead to doctor shopping by patients and resorting to unscientific methods of treatment. This ultimately increases the out of pocket expenditure and workload on the system. Aardram Mission is based on a vision to achieve ideal primary healthcare delivery. But to reach the goal, we will have to equip Primary care physicians with adequate quality training rather than merely setting up guidelines and protocols, which will further drive the public away from the doctor. If all the principles of Family Medicine are incorporated into Aardram Mission, we can definitely expect an improvement in the health indices of Kerala and Kerala model of healthcare could be depicted as an ideal health care delivery system

Editor's notes

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