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Table 11 Thoughts on the state of family medicine in South Africa, strengths and concerns by Couper et al. [69]

From: A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

“We (family physicians) need to be very clear that we are different from other specialties, and not try to be the same. We think that some of our problems derive from the fact that we try to be the same as other specialties and to be seen in the same way, instead of making it very clear that we are completely different, because primary care is different from any other specialty; because our role is in the community, and not in the hospital like other specialists; because our focus is on all patients and not types of diseases or specific groups of patients; and because our approach is holistic, rather than specific. We are generalists who need to coordinate patient care in balance with specialists, who each have their own unique way of making clinical decisions. We need to be experts in health, and to say to our patients that their illnesses are but one part of them as whole people, while the specialist is an expert in saying which sicknesses they do or do not have, in a narrow field.”
“We are extremely worried by reports of family physician specialists who consider themselves to be too important to see patients with so-called minor ailments. We are deeply disappointed to hear students reporting on family physician colleagues saying: “I am a specialist family physician” with great pride, as they strut around and do not see the patients that the other doctors and nurses see, because they are specialists. We feel pain when we hear that our colleagues will not carry out the normal first contact calls, but want instead to perform “consultant calls”, where they sit at home and are only called out on the odd occasion, while still being paid the full amount for overtime. Is that what being a specialist really means? Are we selling ourselves out? This is definitely not the way to gain the respect of our colleagues, the public, or the powers that be that run the health service. We do not think it is the way to gain self-respect either.” [65]