Primary Healthcare: Back to the Basics

This article was exclusively written for The European Sting by Ms. Lilian Teresa Pimentel, a fourth-year medical student at O&M Medical School in the Dominican Republic. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one. Over the past decades, medicine has advanced rapidly in technology and innovation. From the human genome, electronic medical records, and minimally invasive surgery, new areas of study within the medical field have been developed. Nowadays, after graduating medical school, doctors further their education by becoming specialists or even subspecialists. However, due to this rapid flow of information and new scientific discoveries, basic primary care specialties have been overlooked and often considered less prestigious. Primary healthcare (PHC) is a crucial element of any health care system, as it serves as the first contact of the patient with the health system. PHC is often referred to as essential health care, as its providers focus on the patient as a whole and assume the role of patient advisor and advocate. PHC is the base of disease prevention, health promotion, patient’s follow-up care, and early intervention. In contrast, specialty care centers for diseases and specific organ systems focus on specific illness episodes or disease processes. However, specialty care has gradually expanded the scope to include disaster medicine and medical genetics. As a medical student, I have been fortunate to enter an academic program that stresses the value of community medicine, clinical skills, primary care, and research. Early in our career, we participate in regular visits to a local community, sharing community health projects with residents. Later, during our clinical rotations, we visit PHC units located in urban and rural areas. Therefore, this exposure to PHC early in our medical education has provided a valuable toolkit that allows a smooth transition into the teaching hospitals. It has also shaped our doctor-patient relationship skills, helped us to better understand the patient’s illness within the context of family, society, and community, and provided the ability to form relationships with patients and residents while developing clinical competence. In summary, the best way to encourage doctors to have an active role in the PHC workforce is through extensive interaction with communities and patients, early in medical school. Community-based medical education or a curriculum oriented to cultivate PHC through medical school education is needed. This can empower doctors to effectively manage community needs while emphasising holistic health rather than the sole focus on symptoms. To conclude, community-based medical education will not only improve the learning process of future physicians, but will also likewise contribute to preparing doctors to deliver health services in vulnerable communities, and hence further reduce existing health inequities and inequalities. References

1. Kelly L, Walters L, Rosenthal D. Community-based medical education: Is success a result of meaningful personal learning experiences? Education for Health. 2014;27(1):47.
2. Yoo JE, Hwang SE, Lee G, Kim SJ, Park SM, Lee J-K, et al. The development of a community-based medical education program in Korea. Korean J Med Educ. 2018;30(4):309–15

About the author Lilian Teresa Pimentel is a fourth-year medical student at O&M Medical School in the Dominican Republic. In 2015, she joined the International Federation of Medical Students’ Associations and has served as Local and National Coordinators of the Standing Committee on Public Health and Vice-president of External Affairs of IFMSA-Dominican Republic. She has shared her public health experiences through four publications in the IFMSA Medical Student International. She also participates in community service activities of other local and international organizations in the Dominican Republic.