In developing countries, the family persists as a key institution, the centre of the emotional, spiritual and economic life of the individual and the context of the individual's interactions with the community. The majority of the population still live in rural areas where the family-community interaction is close, indeed intense. This remains true too of peasants migrating to urban slums to exist in a new culture of poverty. The family in developing countries represents a more closely shared, psychological, sociological and economic destiny than is perhaps represented by the family in the wealthy nations of the West.
'Health for all by the year 2000' is the promise of the Declaration of Alma-Ata to which all our governments have put their signatures. It is a noble ambition which is impossible to achieve unless the issues of poverty and maldistribution of wealth are seriously addressed. Nevertheless, much progress can be made during a campaign to achieve 'Health 2000' because an opportunity presents to discuss the prerequisites to achieving 'Health for all' and there is pressure to make some progress towards this.
An important opportunity now presents itself to put into effect the new concepts of family practice on a global scale. Hitherto the World Health Organization, (of which WONCA has just become a non-governmental organization affiliate) has not found it necessary to turn to family physicians for advice or expertise whilst organizations of family physicians for their part have shown little interest in the primary health care movement. Family physicians have practised under constraints that have favoured chargeable procedures as against the preventive approach, episodic care as against continuing care, caring for the fee-paying individual as against caring for the family and large panels as against small populations. This practice falls short of our ideals. In developing countries, there is a need for a community-oriented, family-based practice in which the physician and the health care team accept responsibility to work with their community to achieve health for all. We must now give attention to develop this atrophied wing of family practice.
This is truly a historic opportunity that we must seize to make available the concepts and skills of family practice and to universalize the relevance of our way of delivering primary health care. All of us in a great co-operative endeavour can do much for the health of the people of this small globe that we share.
'There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyages of their life
Is found in shallows and miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our venture.'
[Notes added by TCL: Full text of article. The quoted phrase was uttered by Brutus in William Shakespear's Julius Caesar Act 4, scene 3]
Citation: Bentzen BG, Bridges-Webb C, Carmichael L, Ceitlin J, Feinbloom R, Metcalf D, McWhinney I, Rajakumar MK. The Role of the General Practitioner/Family Physician in Health Care Systems: A Statement from WONCA, 1991
Citation: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare & Society: Essays By Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019
First edition: 2008
Contents of second edition:
Preface to the Second Edition iii
Foreword by Dr Harbaskh Singh vii
Foreword by Professor Chris van Weel (in the First Edition) viii
Foreword by Datuk Dr D M Thuraiappah (in the First Edition) ix
Section 1: Primary Health Care and Family Medicine 1
1 Put not New Wine into Old Bottles 3
2 The Importance of Primary Care 6
3 Primary Health for all the People 11
4 The Evolution of General Practice 16
5 Future of Family Medicine in Developing Countries 23
6 Family Practice: Uniting Across Frontiers 27
Section 2: Training for Family Medicine 31
7 Specialisation in Primary Healthcare training for the new General Practice in Malaysia [summary] 32
8 A Proposal for the Training of Physicians in Primary Care for the Rural Areas of Malaysia 34
9 The Family Physician in Asia: Looking to the 21st Century 40
10 Training Family Doctors in a Developing Country 46
Section 3: Family Medicine journals 51
11 Family Physician [inaugural issue of Family Physician] 52
12 Our journal [inaugural issue of Malaysian Family Physician] 56
Section 4: Healthcare Improvement 58
13 The Future of the Health Services in Malaysia. [summary] 59
14 Quality in Family Practice 68 15 Foreword, In: Chee HL, Barraclough S (ed). Health Care in Malaysia 75 Section 5: Ethics and Professionalism 81
16 Ethical Consequences of Technological Change 83
17 Dr Sun Yat Sen Oration. Between Faith and Reason 91
18 Ethics, Professionalism and the “Trade” 99
19 Rural Health and Global Equity: Am I My Brother’s Keeper? 103
20 Achieving Equity Through a Primary Care-Led Health System 108 Section 6: Civil Society 112
21 Looking Back, Looking Forward 113
Appendix 1: Dr M K Rajakumar: A brief curriculum vitae 120
Appendix 2: Books and articles about Dr M K Rajakumar 124
Appendix 3: Reflections and comments 125
Matched MeSH terms: Family Practice; Physicians, Family