rom a global perspective, United Nations has already endorsed universal health coverage as Health for All. The only route to achieving this is primary healthcare which was also defined as Health for All at Alma Ata. How a country deals with the rising disease burden and addresses health inequalities largely depends on the robustness of its primary healthcare infrastructure.

It is important to understand that a family physician/ general practitioner must possess good listening skills and have a problem-solving approach in consultation. This makes primary care physicians different from the disease-centred linear thinking in secondary and tertiary care hospitals. The curricula in medical schools must address this approach.

Primary care consultations focus on the person as a whole, i.e. their body as well as their mind. The latter includes their ideas, concerns and expectations from a consultation.

It must be kept in mind that the family physicians provide care over long periods of time. At times patients present with multiple issues, complex and poorly understood health problems that must be handled. Developing rapport in the doctor-patient relationship is an essential tool. It must be ensured that students who graduate from medical school have a substantial understanding of these matters.

Prescribing medications is a crucial component of physician consultation. Poly-pharmacy or the use of multiple medications in a patient, is commonly seen in elderly patients or those with multiple chronic health conditions. A review of such medications is needed on a regular basis particularly if combination therapy as opposed to mono-therapy is used. Such patients need holistic care and prescribing medications rationally can be a complex task.

Similarly, challenging patient consultations require training which is best initiated at the undergraduate level. Focusing on patient safety through rational prescription and avoiding medication combinations in vulnerable groups to prevent adverse interactions will create a safe and high quality care system.

Primary care consultations focus on the person as a whole, i.e. their body as well as their mind. The latter includes their ideas, concerns and expectations from a GP consultation.

Recently, a webinar was arranged by FACE (Focus Area of Compassion and Ethics), which is part of the task force for Global Health organisation. The main focus was on a discussion around compassion as an engine for primary healthcare. The question arises: what happens in countries or regions lacking primary healthcare systems? Does compassion exist there? Can compassion be taught or acquired? How can it be incorporated into the existing medical education system in low-income and low-middle-income countries? Is compassion being undermined in our healthcare system?

Caring for the wider community and dealing with a variety of cases day in and day out requires compassion. Practicing physicians and future doctors must learn the skill and apply it in their practice. One way of dealing with this is to ensure that the current undergraduate teaching system includes primary care (family medicine), a subset of primary healthcare in its curriculum.

Whole person care is one of the fundamental principles of family medicine. Being the gatekeepers of the healthcare system, primary care physicians, also called general practitioners or family physicians have to have good listening skills, counselling/reassurance skills and advising skills.

Across Pakistan, there are 19 institutions that have FM departments; only 13 have FM undergraduate teachings. The teaching-learning process must include medical rotations of first-year medical students in primary care setups (GP clinics, basic health units, rural health centres). Exchange of students at national or regional level will promote the development of soft skills.

Last but not least, increasing the number of graduating doctors who opt for family medicine (primary care) is necessary. The culture of an educational institution affects undergraduate students and the choices they make. In order to encourage more students to enter general practice, a positive attitude of a university towards family medicine/ general practice is necessary. For resilient and sustainable healthcare, a well-functioning primary care system is a must.

Dr Hina Jawaid is an associate professor in family medicine at University of Health Sciences, Lahore.

Dr Abdul Jalil Khan is an associate professor in family medicine at Khyber Medical University, Peshawar