‘Look forward to knowledge but do not forget to lookback for wisdom’

By Dr. Ruvaiz haniffa

A western medical doctor, who has undergone further training to deliver medical care at primary care level, based on concepts and principles of Family Medicine/General Practice, is a General Practitioner/Family Physician. Family Medicine/General practice is the medical specialty which provides continuing and comprehensive care for the individual and the family. General Practitioners – now commonly referred to as Family Physicians – deal with physical, mental and social signs and symptoms in individuals, their families and the community to deliver quality promotive, preventive, curative, rehabilitative and palliative care in an ethical and professional manner, based on the principles of family medicine which is the academic discipline which underpins general practice. Though, in essence being a ‘generalist’ discipline it is classified as a ‘specialty’ of breath which integrates biological, clinical and behavioural sciences to deliver healthcare in holistic manner.

The Family Physician of today is rooted in the historical ‘generalist’ commonly referred to simply as ‘A DOCTOR’. The reader is encouraged to reflect on who or what a medical doctor means to him/her at an individual, family and community level. In Sri Lanka, the terms general practitioner, private practitioner or family physician is synonymously used to identify a western medical practitioner who may or may not deliver primary curative medical care, based on the principles of family medicine. This directly and indirectly implies that anyone with a medical degree (or not) is deemed fit by the medical regulators of Sri Lanka, in particular, and the Sri Lankan public, in general, as qualified, trained and competent to deliver care to patients based on the concepts and principles of family medicine.

This basically allows every Tom, Dick and Harry (or to contextualize it to a Sri Lankan scenario every Silva, Perera and Fernando!!!) (or put another way every Community Physician, Oncologist and Cardiovascular surgeon!!!) to engage in General Practice. This puts patients in harm’s way and gives genuine general practitioners a bad name and image, professionally. This creates a vicious cycle which leads to the academic discipline of family medicine to be looked down upon as an ‘inferior’ or even ‘incompetent’ medical discipline as compared to other medical specialties. This in turn leads to unnecessary medicalization of health issues and leads to a disease-based approach to healthcare at an exorbitant cost for the individual and society. The outcome of this is patients expecting and doctors complicitly delivering disease care as opposed to healthcare when often it is clearly unnecessary. There are many within the disease care industry who directly and indirectly benefit financially and otherwise from this philosophy.

BACKGROUND

The concepts and principles of family medicine are as old as the field of medicine itself. Family medicine as an academic discipline is comparatively new. It was accepted as a distinct academic branch of medicine in the UK in 1952 and in the USA in 1969 and In Sri Lanka, it was recognized as a distinct clinical discipline in May 1979.

In Sri Lanka there is no historical record of self-employed western medical practitioners during the colonial occupations by the Portuguese or even the Dutch. One of the earliest references to self-employed western medical practitioners is in the year 1835 during the British colonial occupation. These records state that a western medical practitioner, named Dr Misso, ‘opened an exceedingly well-furnished dispensary in Pettah after spending 20 years in public service’.

Towards the end of the 19^th century, many Ceylonese doctors, who were products of the Ceylon Medical College (presently the Faculty of Medicine, University of Colombo) took to private practice and established independent clinics outside the state healthcare system in Colombo and Kandy gradually moving to other major towns and villages.

With the increase in their numbers, by the early part of the 20^th century, there were quite a few general practitioners all over Ceylon. A logical development of the proliferation of those engaged in general practice was the formation of an association to look after their interest and ensure their continuous professional development. This led to the formation in 1929 of The Independent Medical Practitioners Association (IMPA) vibrantly existing even today. Dr E.V. Ratnam (founder of one of the first private hospitals in Sri Lanka – The Ratnam’s Hospital – established in 1907) was the prime mover in the formation of the IMPA and was its first President until 1950.

Other key figures who served as Presidents of the IMPA were Sir Frank Gunasekera (1950-51. Served as personal Physician to the British Governor), Dr M C M Kaleel (1952-63. Founder Member of the UNP, Cabinet Minister and Chairman of the UNP), Dr A D P A Wijegoonawaredne (1963-68. President of the Commonwealth Medical Association and Ceylon Medical Association), Dr A M Fernando (1969 -70 Founder Chairman of the Board of Study in Family Medicine at the PGIM), Dr R. P Wijeratne (1970-71) and Dr M P M Cooray (1971-75. First President of the College of General Practitioners of Sri Lanka)

The IMPA was a medico-political body with academic general practice as a subsidiary interest amidst the many professionally related issues it had to deal with at its inception and formative years. Nevertheless, in the 1960s the leaders of the IMPA identified the need for a separate entity to spearhead and dedicate itself as an organization to the academic discipline of General Practice. This idea was the embryo which, over the years, developed into the College of General Practitioners of Sri Lanka, the apex professional and academic body of all grades of general practitioner in the private, state and academic sectors in Sri Lanka. In 1969, Dr A M Fernando, attended the convention of the General Practitioners of Australia, in Sydney.

During this visit, he experienced firsthand the benefits of a formal organization dedicated to GPs and how it played a role in the continuous professional development of its members which, in turn, led to quality primary curative care to patients. He shared his experience with the IMPA membership who, too, were convinced of the benefits of such organization and its advantages to the healthcare system of the country. Dr C E S Weeratunge, a General Practitioner and member of IMPA, was appointed Secretary to the Ministry of Health in 1970 and having been convinced of the idea for the need of a organization for academic family medicine he lost no time in facilitating the idea of a College for General Practitioners and converted it in to reality along with a team of colleagues spearheaded by Dr G M Heennilame.

The procedural and legal aspect of this venture commenced in 1972 and culminated on the 19^th of August 1974 when, under the able guidance of the Speaker of the House Mr. Stanley Thilakaratne and the Clerk of the House Mr. Sam Wijesinghe, Mr. Ronnie de Mel Member of Parliament for Dondra (later Finance Minister) presented the Bill which was approved and brough in to existence the College of General Practitioners of Sri Lanka (CGPSL) by an act of Parliament.

For the record the CGPSL came into legal existence by way of Parliament Bill No. 26 of 19^th August 1974. The inaugural meeting of the founder members of the College was held on 6^th September 1974 at SLMA House. The first general meeting was held on 18^th February 1975. At this meeting all qualified doctors, who were eligible for membership, according to the Bill, were enrolled, subject to the confirmation of the Council. In all 118 members were enrolled on that day.

I take this opportunity to place on record my eternal gratitude to the Independent Medical Practitioners Association of Sri Lanka for having the vision and courage to create the CGPSL as an independent entity and for all the guidance and support it gave the CGPSL in its formative years.

MAJOR ACHIEVMENTS

Since 1975 the CGPSL has taken giant strides to firmly establish Family Medicine as a distinct clinical, specialty in Sri Lanka, amidst a myriad of hurdles. On this momentous occasion of our 50^th Anniversary please permit me to share with you a brief list of unique achievements we have made as a college over the years.

* Establishment of the Board of Study in Family Medicine, at the Post Graduate Institute of Medicine (PGIM) of the University of Colombo

Through this academic activity the College laid the post graduate educational foundation for every single trainee in family medicine who went through the Diploma in Family Medicine Programme and all those who have gone through, are going through and will go through the MD in Family Medicine programme in Sri Lanka.

It must not be forgotten that the entire effort in creating this Board of Study was shouldered by Members of the CGPSL. Of the initial 10-member board five were Members of the CGPSL, including the Chairman and Secretary of the founding Board. The stewardship of this pioneering Board is considered the Golden Era which ushered Family Medicine as an academic disciple into the medical and postgraduate medical education spheres in Sri Lanka and beyond. The CGPSL, through the BoS, successfully conducted the Diploma in Family Medicine (DFM) exam in Chennai, India, in collaboration with the College of General Practitioners of the Indian Medical Association (CGPIMA). As such there are quite a few Indian Doctors with the DFM-Colombo qualification in Indian even today. To date this remains the only post graduate medical examination conducted in a foreign county by the PGIM.

* Introduction of Family Medicine to the undergraduate medical curriculum

At the request of the CGPSL the Faculty of Medicine, University of Colombo, began sending its students to General Practitioners in the Colombo area for three half-day sessions in 1980 to expose them to the discipline. The NCMC, which was established in 1981, had a Department Family Medicine in 1983 where students were given formal theoretical and practical inputs into Family Medicine for the first time in Sri Lanka. Subsequently the Universities of Sri Jayewardenepura and Kelaniya established Departments of Family Medicine in the years 1993 and 1994, respectively. The University of Colombo established a Family Medicine Unit in 2002 and converted it to a Department of Family Medicine in 2018. The Universities of Jaffna, Rajarata, Eastern and Ruhuna have either commenced or are in the process of establishing either Departments or Units to teach Family Medicine.

International Partnerships and Collaborations*

World Organization of National Colleges Academies and Academic Associations of General Practice – WONCA

WONCA commenced in the year 1972 and the CGPSL formally joined in 1978 at its 8^th meeting held in Geneva, Switzerland, though professional and academic contacts had been going on since 1976.

Earlier this year in conjunction with the 50^th anniversary of celebrations of the CGPSL, the WONCA South Asia Regional meeting was hosted by the CGPSL in Colombo 3^rd to 5^th May 2024 at the Shangri-La Hotel. Sri Lanka. They had twice previously hosted this conference (2005 and 2016),

This event was marked by the Philatelic Bureau of Sri Lanka issuing a commemorative stamp and first day cover marking the event.

Many members of the CGPSL play active roles in WONCA with great distinction.

* Royal College of General Practitioners of the United Kingdom

The CGPSL established formal links with the Royal College of General Practitioners of the UK in March 1978 with the visit to Sri Lanka of the Dean of Studies of the RCGP, Dr J S Norell. He was able to give technical inputs in to organization of educational programmes for the membership. This link was renewed in 2003 with the CGPSL taking a lead role negotiating with the RCGP to conduct the Membership exam of the RCGP in the South Asia region. Many CGPSL members underwent training to function as examiners at this exam. The first MRCGP[INT]-South Asia exam was held in 2007 in Colombo. This exam is now held three times a year in rotation in Colombo, Chennai and Karachi. A Past President and Senior Member of the CGPSL Dr. Preethi Wijegoonawardene was elected as the Chair of the MRCGP[INT]-South Asia Examination Board in 2016.

Establishment of the North Colombo Medical College

The CGPSL initiated the creation and establishment of a private medical college, called North Colombo Medical College, which now carries on as the Faculty of Medicine, University of Kelaniya. The NCMC produced about 300 Sri Lanka and overseas nationals as doctors who serve their patients in Sri Lanka and throughout the world.

When Dr G M Heennilame first brought up the proposal of a private medical school in 1975 at a Council meeting of the CGPSL, he was ridiculed and had to face raucous laughter and cynical comments from his colleagues in the Council who did not allow him to continue his presentation. He re-presented his proposal in 1980 at the AGM having further refined it. The proposal won unanimous support from the general membership. Following this, a memorandum was submitted to His Excellency J R Jayawardene, ihe President of Sri Lanka at the time.

The Health Minster Mr. Gamini Jayasuriya was instructed by the President to follow the matter up with the CGPSL along with Secretary Health (Mr. B C Perera) and the Director General of Health Services. A series of logistical, medical educational, health service delivery and financial meetings with relevant officials took place and the President, on the recommendation of his officials, approved the long lease of the Thalagolla convalescent home with 5 to 10 acres of surrounding land in Ragama and designated the North Colombo General Hospital as the teaching hospital for the proposed private medical college.