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Progress in family medicine in Slovenia |
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| The development of family medicine in Slovenia Under the influence of Andria Stampar and other country's opinion leaders in social medicine and the impact of socialist government in former Yugoslavia, which claimed health care system as one of the parading horses of the regime there was an important emphasis on the development of health care services in the country in the fifties. There were large investments in the premises especially in the primary care field throughout the country. A range of preventive activities were implemented in the primary health care centres on the national basis: well baby clinics, well mother clinics, clinics for women, clinics for tubreculosis, clinics for trachoma, clinics for workers, clinics for schoolchildren and students etc. Many of the physicians working in these clinics pursued their professional careers in the specialist field that they covered in those clinics. Under these events, under the decline in holistic and generalist thinking in specialised medicine and under the Soviet policlinic approach at the end of fifties and the begin of sixties there was a threat that general practitioners would sooner or later die out. Only a few enthusiast believed in family medicine as an important source of care. In the 1960's the code on the medical fields declared family medicine (in that time general medicine) as one of the specialist fields. But vocational training was not a prerequisite for working in general practice. After medical school and one year of residency physicians were supposed to be able to work in the practice. Especially in Croatia many physicians completed vocational training and took a lead alongside with the School of Andria Stampar in Zagreb in motivating general practitioners throughout former Yugoslavia to join in an association. As a result of these efforts Slovene family medicine society and Yugoslav family medicine association were established in 1966 [5]. The Society played an important role in raising the awareness and in preparing conditions for the university department, mandatory vocational training and recognition of family practice in the professional and lay community. The first attempt to establish General practice department was in 1975. It will be remembered by the quotation of the rhetoric question of one otherwise rather unimportant professor of internal medicine at the faculty board: "How something that holds in its name general (general practice) can be treated as special (specialist field)," which undermined well prepared plans for the department as well for the institute of general practice. Colleagues in Croatia were more successful. They got the Department of family medicine in 1979 as one of the first in Europe. |
This event was hard and devastating for general practice at that time. But the lesson is the one to remember: There is no king's path, there are only hard work, clear aims and devotion that can build a critical mass which could not be resisted in appropriate time frame. The leaders of the Society recognised the importance of own research, own continuing medical education, own publications and own academics. First actions were undertaken in the CME field. The Society started to organise own courses. Today, we organise up to ten workshops, congresses and courses of CME yearly and publish proceedings which serve basic needs of our family physicians. Besides co-operation with the colleagues in other Yugoslav republics, international contacts were established in the eighties and especially in the early nineties after the declaration of the independence. These contacts serve as a source of research co-operation on the international projects and as a source of political support to our efforts. Professionals needed for the academic recognition of the family medicine evolve from those research projects. Next important step was to change the name of the department, the name of speciality and the profile we were aiming at: Instead of general practice we started to talk about family medicine to overcame the linguistic barrier in our efforts to become recognised as speciality. In November 1995 after one test year Department of family medicine was established at Ljubljana University. The curricula are unique in this field
[6]: during seven week course lectures are kept to a minimum of two lectures, one day a week students spend with an assistant teacher in small group work which consists of reports about the experience in the practice, project reports, medical decision making sessions, videotaping consultations with simulated patients and discussing communication skills. The rest of the week students stay with their specially trained
tutors in the practice to test the knowledge they gain on communication skills, medical record keeping and to learn practice management and disease management skills. The numbers of in service vocationally trained doctors raised recently to the two thirds of all practising in general practice but it took decades that the law has passed and from the year 2000 the vocational training for family medicine is adopted by the regulating bodies in the country and completing vocational training became mandatory condition to be licensed. |
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