We are not multi-competent specialists
– we are much more than that!

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Dr Frikkie Kellerman

A family physician is not a multi-competent specialist! He (or she) is much more than that! A family physician is a specialist in the practice of family medicine…

The best way to illustrate this truth is to think of the baking of a carrot cake! We may put all the different ingredients together on the table, but we do not have a carrot cake. We may thoroughly mix all the necessary ingredients together, but we still do not have a carrot cake! The mixture needs to be put into the oven and properly baked – only then, and only after quite a while, will it come out, completely transformed – a delicious carrot cake!

In the same way, we may increase and expand a physician’s knowledge and skills in the practice of dermatology, orthopaedics, paediatrics, gynaecology, obstetrics, otolaryngology, psychiatry, surgery, internal medicine, radiology, cardiology, ophthalmology, etc., …but this does not automatically make him (or her) a transformed, integrated, true family physician! This is extremely important to realise.

The end product is more than the mere combination of the different ingredients. Already in 1926, Jan Smuts said in his book on “holism” that “the whole is more than the sum of the parts.” That is why we say, also in the making of a true family physician, the “whole is more than the sum of the parts,” and, a family physician is more than a multi-competent specialist!

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It still leaves us with the fascinating question: “Who is a family physician?”

The least we can and should say, firstly, is that a family physician is a physician for the family. He (or she) focusses on the family. A family physician therefore thinks “family,” breathes “family,” assesses “family,” assists “family,” treats “family,” visits “family,” builds “family,” counsels and cares for “family,” and seeks to promote “family” health, while not neglecting his (or her) own family…

Secondly, a family physician focusses on “the primacy of the person” of the patient (Henbest, 1989). To him (or her), the person of the patient is of more importance than merely the problem of the patient. By focussing on the person of the patient, he (or she) will naturally make sure that the problem of the patient is competently and compassionately cared for, but his (or her) focus is not on the mere problem, but on the person of the patient. Furthermore, realising that “it is the spiritual which makes the person” (Tournier, 1957), he (or she) does not ignore the spiritual and does not focus on the physical (the so-called “bio-medical”) alone! This is extremely important, especially in the light of the literally thousands of studies showing the link between spiritual health, psychological health, relational health and physical health. In the “Textbook of Family Medicine,” Dr Ian McWhinney (2009) said, the prime foundational principle of Family Medicine is that “family physicians are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique.”

Thirdly, a family physician uniquely attends to and promotes the “wholeness of the whole” person, the whole family, the whole community (to a limited extent), and his (or her) own whole family… With “wholeness” we mean “the whole” or “all the aspects, all the components, all the dimensions, all the facets” of a person, as well as “the whole” in the sense of “all the members, all the persons.” We also mean the completeness, the integrity, the harmonious togetherness, the wellness of all the dimensions and members, including all the relationships between all…

To help us, practically, to implement this ideal approach to the practice of true family medicine, there is nothing better than the comprehensive understanding and utilization of the Three-stage Approach to the assessment and management of persons and their problems. True family physicians are the worldwide leaders in this approach. To a family physician, the Three-stage Assessment and management approach refers to the appropriate attention given to (1) the Clinical (the physical), (2) the Individual (the psycho-spiritual), and (3) the Contextual (the social) dimensions when seeing a patient or family. The article “In Search of Excellence. Expanding the Patient-centred Clinical Method: a Three-stage Assessment,” by Fehrsen and Henbest (1993), describes the initial development of this magnificent approach beautifully.

We dare say that a physician that does not use the Three-stage approach as an integrated way of thinking, being, assessing and assisting persons, families and communities, is not a true family physician.

Apart from this aspect of the comprehensiveness of care by a family physician, there are also the equally important aspects of continuity of care, collaboration and coordination of care, cost-effectiveness of care, compassionate care, client-centred (patient-centred) care, community-oriented care, etc., which cannot be dealt with here.

Fourthly, the crux of care is still the priority and practice of good, personal, pure, professional inter-personal relationships between the physician and the patient, the physician and his (or her) peers, the physician and his (or her) family, and between the physician and God.

From just these few points, it is clear that a true family physician is much more than a mere “multi-competent specialist,” and that “the whole is more than the sum of the parts.”

We end by referring again to our carrot cake … We saw that, for the mixture of the different ingredients to be transformed into a delicious carrot cake, a certain process is needed! In the same way, a life-transforming process is needed for us to become, not mere multi-competent specialists, but competent, confident, compassionate, caring, comprehensive, humble, hard-working, happy, holy, hearty, harmonious, true family physicians. May it be our humble expectation and happy experience – for the good of our patients and communities, and for the glory of God.

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References Smuts JC. Holism and Evolution (2^nd edition). MacMillan and Company, 1927.
Henbest RJ. Patient-Centred Care: A Review of the Concept. S Afr Fam Pract 1989; l0: 454-63.
Tournier P. The Meaning of Persons. London: SCM Press Ltd., 1957.
McWhinney IR and Freeman T. Textbook of Family Medicine (3^rd edition). New York: Oxford University Press, 2009.
Fehrsen GS and Henbest RJ. In Search of Excellence. Expanding the Patient-centred Clinical Method: a Three-stage Assessment. Family Practice, Volume 10, Issue 1, March 1993, Pages 49-54.

Editor's notes

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