Family doctors can heal system

The treatment of patients by family physicians is centred around public health, handling all problems related to daily living.

“We have the wrong type of health care because we don’t have a strong primary care system,” said Prof Salman Rawaf, speaking at the Arabian Public Health Forum 2010 in Abu Dhabi on Monday.

ABU DHABI // Leading health officials have lambasted the "weak" primary healthcare system, and called for family doctors to be put at the heart of health services.

At a forum in the capital, senior doctors said the region's lack of a strong public health infrastructure and, subsequently, of leaders in public health, was the main challenge for healthcare providers.

The calls were led by Salman Rawaf, professor of public health and director of the World Health Organisation Centre at Imperial College London. "If we asked ourselves whether we have a weak or strong healthcare system in the Gulf, we would have to say weak," he said. "We have the wrong type of health care because we don't have a strong primary care system." He was speaking yesterday at the two-day MEED Arabian Public Health Forum in Abu Dhabi, as part of a discussion on reducing the impact of chronic diseases in the region.

Prof Rawaf said that aim would be all but impossible to achieve without dedicated public health programmes. In the UAE, the capital's Corniche Hospital is the only one with an integrated public health programme, with dedicated staff. Dr Ali al Marzooqi, the Dubai Health Authority's head of public health, said he was unaware of any public health programmes or centres anywhere in the region. Prof Rawaf put the blame squarely on the lack of prominence of family doctors.

"Sixty per cent of what a family physician covers when treating patients is centred around public health," he said. They conduct screening, counselling, analysis and therapeutic conversation. They often even end up doling out travel advice, he said. About 30 per cent of the time, patients see doctors over problems related to their daily lives. These include school problems, financial woes, psychosexual issues or social stress.

The family doctor, he said, deals with all the ills of a community, and is "the only person in medicine who can look at things in a holistic way and address needs of the patient both short term and long term". Despite this, he said, patients tend to head straight to a consultant or a specialist. This can be because their insurance policy allows them to, or because they do not understand the importance of primary healthcare providers nor trust in their ability to help.

More than that, they skip primary care because of the lack of a proper infrastructure. "General practitioners need to be trained and accredited. It is criminal to have a doctor straight out of medical school go straight into a clinic or private practice, with no supervision," he said. In the case of diabetes, for example, which affects one out of five people in the UAE, Dr Belal al Shammaa, director of the diabetes centre of excellence at Dubai's American Hospital, said only public health programmes would probably to generate the type of awareness that would persuade people to get screened regularly.

"We have to increase patient accessibility to primary care, so they are not reliant on specified diabetes centres and consultants, after the disease has already set in," he said. "Unfortunately, most primary care systems here are not up to standard as there are no benchmarks, and people are left untested and unscreened. No one is watching out for them." Dr Maha Barakat, medical and research director at the Imperial College London Diabetes Centre in the capital, said primary care doctors should be trained to treat and to prevent diabetes.

"Through prevention and public health, we will empower the community to look after not only the one in five patients with diabetes ... but we will also keep an eye on everyone else and prevent disease from setting in," she said. According to Prof Rawaf, in any given population, four in 10 are healthy, another four are healthy but have one or two risk factors such as high cholesterol or obesity, one has an acute illness and the remaining one in 10 has a disability.

"We are 80 per cent healthy, more or less, and yet everything is disease oriented," he said. A stronger primary care system would switch the focus to prevention. Instead of treating an illness, make sure it never happens, he said. "Without a public health programme, and a strengthening of primary health care, that cannot happen."