General medicine, family medicine.

The term family medicine defines treating the patient while taking his family context into account. Treating several family members in the same practice can be an advantage, but also a disadvantage. Possible conflicts or delicate situations can arise when the people responsible for the patient are not the ones most emotionally involved or closest to him.

Most of the time, a patient who needs medical support from us will also need emotional and financial support from his family. Within these needs, one of the biggest forms of discrimination can appear. People from disadvantaged social backgrounds are indirectly discriminated against because, generally, they have fewer resources and means to access healthcare. Beyond that, they may even encounter direct discrimination.

Let's talk through concrete examples, because this is a subject I care deeply about, since it can increase morbidity and mortality.

Indirect discrimination comes from a lack of money and available time. A bank director will be able to make time to get to the doctor, and he'll get there in his Mercedes. Likewise, he won't have any trouble buying the medication he needs from the pharmacy.

An unemployed person or a cleaning woman most likely has to fit her doctor's appointment around the bus schedule or the shifts she has to work. The 10 euros she has to spend at the pharmacy might be the last money she has.

When they show up at the practice, while the director is shown into the room for private patients and offered a coffee, the cleaning woman, the unemployed man, or the homeless person might even be turned away from the consultation based on appearance alone. This way, the same acute bronchitis can lead one of them to be hospitalized. Can you guess which one?

If this blog ever teaches you anything, it should be this. The poorer and more destitute a patient is, the more he is put at risk and the higher his mortality.

I know you all want to treat only patients who are young, clean, and well-groomed, but the ones who actually need you are the dirty, unwashed ones with torn clothes. The only question is whether we care enough.

For this reason, contrary to what most textbooks in the field say, we must always assess the patient's social status, even within the family. The lower that status, the more obligated we should feel to protect the patient, even within his own family.

Serious chronic illnesses that affect quality of life can exhaust not only the patient physically and emotionally, but the rest of the family as well. How many times have we all heard the phrase: "I couldn't make it to the doctor because I was taking care of my mother. She died two months ago, and now I feel like I need to take care of myself."

Religious or cultural differences can be another source of conflict between family members, and they're not always understood by the doctor.

Because of all these potential issues, it's advisable, when receiving a patient at the practice, not only to take a medical history, but also a family one, including a description of the relationships between family members. Unfortunately, we don't always have time for that.

The definition of family medicine best shows the doctor's clear role. Every patient has several resources available, but we are the most important one.

A grandfather with chronic bronchitis and heart failure only has a 30% charge, while his grandson with a sore throat has 95%. Since we are their main resource, we have to bring both of them to 100%. This variability in the doctor's role as a resource is best seen when we treat different members of the same family.