FAMILY MEDICINE DEPARTMENT IN A TERTIARY HOSPITAL – A PARADOX?

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Dr. Resmi S Kaimal

Lourdes Hospital is one of the best tertiary care hospitals in the city of Kochi in Kerala. It is undoubtedly the first private tertiary care hospital in Kerala which started a dedicated Family Medicine department. There were a few questions raised at the start, many challenges faced over the years and also great goals accomplished along the way.

This hospital was founded in 1965 with the aim to provide quality accessible healthcare to the residents of the islands which surrounded the city of Kochi. The hospital started DNB Family Medicine training in 2005, but it was only in 2012 that a dedicated Family Medicine department was formed.

The idea of Family Medicine in a tertiary care hospital seems like a paradox. We too were sceptical to some extent initially, but the growth of the department and the role it plays in our hospital has cleared all doubts. Also, the feedback we receive from patients, our colleagues in other specialties as well as hospital management is encouraging.

There were many queries regarding the role and relevance of Family Medicine in our hospital, as this is a community based specialty. Why would a person coming to a tertiary care hospital seek a family physician’s care when he had a choice of all specialities under the same roof? What category of patients should be seen by a Family Medicine specialist? How can a family physician in a hospital provide patient-centred care in the context of the patient’s family and community?

Another important challenge was that the new department should not be confined to a preventive health check-up unit or an employees’ clinic. It should neither be restricted to geriatric or palliative care patients.

With all these in mind, the new department was started with the following services:

1. General OPD
2. Domiciliary (Home) care
3. Community outreach clinics
4. Medical camps
5. School health
6. Health education
7. Training and research in Family Medicine

General OPD: Out-patient clinic was aimed at providing primary and continuing care to patients of all ages, both sexes and any presenting complaints. Those presenting to the registration counter/ reception of the hospital with undifferentiated or multiple complaints are directed to Family Medicine OPD by the staff. This also serves as a fast track OPD for patients unwilling to stand in long queues before other specialty OPDs, for non-emergency patients presenting to Emergency department and for patients attending to subspecialty OPDs for routine reviews. Women and child health issues also present to the OPD. Minor surgical procedures are performed in the procedure room. Whenever required, care is co-ordinated with other specialists.

Domiciliary Care: This was a part of the “Lourdes at your doorstep” initiative which upheld the vision and mission of the hospital. When this idea was presented and executed, it was one of the earliest such services in the city. Later, many palliative care units and hospitals have started palliative home care services. Our domiciliary care is not restricted to palliative care patients alone. We offer home care to pre-registered patients upon request. The team consists of doctor, staff nurse, nursing assistant and ambulance driver. We cater to patients of different socioeconomic strata. Home visit is a very important aspect of practice of Family Medicine. Each home visit teaches us a new lesson and the experience so gained has definitely improved our understanding of the context and burden of illness.

Community outreach clinics: We have 11 community outreach clinics at present in and around the city of Kochi. The postgraduate residents of Family Medicine department manage these outpatient clinics. There is provision for dispensing medicines and lab services too. These community outreach clinics serve as an option for affordable healthcare to people who have less access to main hospitals in the city.

Medical camps: Through free medical camps, we provide screening services for lifestyle diseases as well as primary care for acute and chronic ailments. Some of the special medical camps we had were medical aid for people at flood relief camps and camps for migrant labourers.

School Health: We conduct school health camps at various schools in the urban and rural areas of the district to ensure positive health for the future generation.

Health education: Awareness classes on a variety of topics like first aid, Common cancers, lifestyle diseases, adolescent health etc. are being conducted by the department to educate people about their health and the role of prevention in healthcare.

Training and Research: Lourdes Hospital and Postgraduate Institute for Medical Sciences and Research is an accredited centre for conducting DNB in Family Medicine by National Board of Examination, New Delhi since 2005. This is a 3 year residential training in the specialty of Family Medicine. The residents have rotational posting in various departments in the hospital as well as in the community and actively participate in all the activities of the department. As part of training, the residents do research on a variety of topics. The department of Family Medicine at Lourdes hospital has many research publications to our credit.

Though Family Medicine is a community oriented specialty, there is a place for our specialty in a tertiary hospital also, as we learned from our experience. The training in family Medicine can be centred at hospitals with a dedicated department and at the same time provide community oriented training through its satellite clinics. We have proved that the different facets of Family Medicine like continuous comprehensive care, patient-centred care, community-based care, preventive care and health education can be incorporated into a tertiary care setting for the benefit of patients and the community.

Acknowledgements:
Rev. Fr. Sabu Nedunilath, Former Director Lourdes Hospital (2011-2017)
Rev. Fr. Shaiju Augustine Thoppil, Director, Lourdes Hospital
Dr. Somu Abraham, DNB co-ordinator, Lourdes Hospital
Dr. Paul Puthuran, Medical Director, Lourdes Hospital
Dr. Santhosh John Abraham, Medical Superintendent, Lourdes Hospital

Editor's notes

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Dr. Resmi S Kaimal

M.B.B.S. , DNB Family Medicine
Consultant,
Dept.of Family Medicine,
Lourdes Hospital,
Kochi, Kerala.

President, AFPI Kerala
Treasurer, AFPI National