With advances in Medicine and Healthcare, the related terminology has also become extensive over the years. ‘Primary Care’ refers to the first line of response in a non-emergency situation. These doctors understand what may be the issue and then take the necessary steps. In contrast, Specialized Care is what you get when the exact nature of the problem is diagnosed and treatment must be provided. Specialized Care is provided by Specialists (oncologist/cardiologist, etc.) while Primary Care is provided by Primary Care Physicians.
Primary Care is again of two types – Internal Medicine and Family Medicine. The doctors concerned are respectively called as Internists (not the same as an ‘intern’ who is a medical student undergoing training) and Family Doctors (also called General Practitioners). Not everyone is aware of the difference between the two but nevertheless, it’s important to know this. For one, it will explain why sometimes the doctor is able to handle the situation by himself/herself and why sometimes he/she refers the patient to another person.
Although Medicine and Healthcare are as old as civilization itself, Modern Medicine has a history of around 200 years. Renaissance and Reformation followed by the Industrial Revolution led to more and more scientific knowledge being applied to all spheres of life including Medicine. By the late 1800s, there was a better understanding of the functioning of internal organs in the human body and how to treat what condition. Doctors with such knowledge came to be known as doctors of Internal Medicine. By the early 1900s, Medicine and Healthcare for children started emerging as a distinct specialty called Pediatrics.
So by the 1930s, there were 2 distinct types of doctors -Internists who catered to adults and Pediatricians who catered to children. Many specialties also started emerging at the same time. While this was good for science, it was not good for the family as a unit. Families had to now consult two different doctors for different members, often leading to disjointed care that lacked continuity. To address the problem, Family Medicine emerged around the 1960s to ensure continuity of healthcare as the person goes through his/her lifecycle.
As mentioned above, Internists solely cater to adults (18 to 60 years of age, mostly) while Family Physicians cater to all age-groups, from infants to growing children (pediatric) to adults to seniors (geriatrics). As much as 10-15% of their patients are children while the rest are adults and seniors.
An earlier article by us outlines the advantages of having a family physician.
Internists are aware of general medical issues but in addition to that, they have significant experience and education in many specialties and sub-specialties such as infectious diseases, psychiatry, orthopedics, dermatology, ophthalmology, sleep medicine, palliative medicine, etc. This means, they can provide complete care for men and women at every stage of life.
In contrast, family physicians can diagnose and treat a wide spectrum of medical conditions for patients of all ages. They address preventative medicine and can handle many simple procedures like abscess drainages, laceration repair, simple fracture care, removal of foreign bodies from the skin or eyes, excision of skin lesions, giving joint injections, administering nerve blocks, executing diagnostic procedures such as sigmoidoscopy or, proctoscopy, simple gynecological testing such as pregnancy tests, etc. The internist can also do all of the above but may choose not to and leave it to the Family Physician.
In short, an Internist dives deep while a Family Physician spreads wide. The Family Physician will refer the patient to a specialist when required.
After graduation, doctors must go through a residency program or training. This is generally of 3 years in most countries of the world.
Internal medicine residents get significant training in critical care, emergency medicine and medical sub-specialty care. They must treat hospitalized patients or in-patients for three years. Whereas Family practice residents first go through one year of in-patient training similar to that of the Internists. The remaining two years are split among OB/GYN, pediatrics, cardiology and other outpatient medical specialties.
Both during the training and then practice for the rest of their career, Internists are largely relegated to in-patient care in hospitals. They have a tight schedule and must attend to calls at the hospital irrespective of the time of day.
In contrast, Family Physicians both during training and then practice for the rest of their career focus on outpatient procedures in office or small clinic settings. They are even free to visit patients at home. They can choose the schedules, number of days of the week they work and can plan holidays or vacations at will.
For medical students, choosing between the above 2 branches of Primary Healthcare is a matter of choice based on their personal preferences.
For patients and their family members, the choices are clear. If you have a family physician, he/she will treat you if it’s a minor procedure and direct you to a specialist if it’s a more serious condition. But if you do not have a Family Physician, and go to a hospital for whatever issue you have, the front office will guide you to an Internist or Family Physician as per their discretion and availability of the doctors. And whichever type of doctor you meet, he/she will take the necessary steps so that you receive timely and relevant treatment at the earliest.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
