Ain Shams university PIONEER Training & Development Family Physicians with no Frontier Society (FPNF)

Proposal for Diploma in Family Medicine

By: Prof. Samir Mossa, MD, PhD, MRCGP(UK) Professor in Family Medicine 2007

OBJECTIVES At the end of this course the candidate should be able to: 1. Know the theory, principles and concept of family practice/general practice discipline. 2. Acknowledge the family structure and the community structure and deal with them. 3. Know the principles of the consultation style and have the ability to conduct it thoroughly and neatly. 4. Implement the concepts of counseling style, when and how to use it during his/her practice. 5. Apply the necessary investigations and avoid the unnecessary ones. 6. Have the ability to conduct the prevention concept during his/her consultation. 7. Acknowledge the concept, theory and the application of evidence- based practice in family medicine. 8. Appreciate the ethics and put it in practice. 9. Care for his/her patients and their families. 10. To be a good communicator, establisher and maintainer of good relationship.

MISSION STATEMENT
Establishing an academic and training course to supply Egypt and Egyptian population with competent Family physicians, academicians, auditors and trainers beside family practice team members to lead a comprehensive, integrative and collaborative health care delivery system, economically-efficient, communitybased and culturally-oriented in the new millenium. Prof. Samir Mossa, MD,PhD Professor in Family Medicine

FAMILY PHYSICIAN Is a licensed medical graduate who gives personal, primary and continuing care to individuals, families and a practice population, irrespective of age, sex and illness, it is the synthesis of these function which is unique, they will attend their patients in the consulting room and in their home and sometimes in a clinic or a hospital. Their aim is to make early diagnoses, they will include and integrate physical, psychological and social factors in their considerations about health and illness. They will be expressed in the care of their patients, they will make an initial decision for every problem which is presented to them as doctors, they will undertake the continuing management of their patients with chronic, recurrent or terminal illness. Prolonged contact means that they can use repeated opportunities to gather information at a pace appropriate to each patient and build up a relationship of trust which they can use professionally. They will practice in co-operation with other colleagues, medical and non-medical. They will know how and when to intervene through treatment, prevention and education to promote health of their patient and their families. They will recognize that they also have a professional responsibility to community. Leeuwenhurst, 1974 Family Practice Is a specialty which provides continuing and comprehensive health care for the individual and the family. It is the specialty in breadth that integrates the biologic, clinical and behavioral sciences. The scope of family practice encompasses all ages, both male & female. It also involves each organ system, and every disease entity. The specialty of family practice is the result of the evolved and enhanced expression of general medical practice and is defined uniquely within the family context. (AAFP, 1993).

Family physician is the physician who is primarily responsible for providing comprehensive health care to every individual seeking medical care, and arranging for other health personnel to provide services when necessary. The family physician functions as a generalist who accepts everyone seeking care, where as other health providers limit access to their services on the basis of age, sex and/or diagnosis. (WONCA, 1991) Rationale of the project Few family medicine departments in the Egyptian universities with improper curricula. Few post-graduate programs of family medicine with improper curricula. Lacking of continuing medical education (CME) and/or continuing professional development(CPD) programs for existing practitioners. No clear cut idea about the concept of family medicine or the role of family physician within the Egyptian health care delivery system. No clear cut idea about career of family medicine or the future of family physician. Family medicine is a medical specialty in its own including bulk of knowledge, skills to be mastered and attitudes to be expressed. Egypt is in bad need for qualified family physicians, academicians, researchers, auditors and trainers to lead the health care delivery system. Egypt in fact is lagging behind other countries in application of family medicine concept internationally and regionally. The development of family practice has been given high priority by the Minister of health and population in Egypt and goals were established as the following:- Improvement in the quality of health care delivery in various parts of Egypt whether urban or rural.

- Provision of CME for all physicians, especially those working in rural area, where access to medical knowledge is limited. - Enhancement of public relations especially Doctor-patient relationship. Fragmentation of the services which should be included under the umbrella of family medicine which in turn will reduce the cost if it is delivered by a well-trained family physician.

PROJECT FOR THE DIPLOMA IN FAMILY MEDICINE/GENERAL PRACTICE TOTAL: 6 Months Total: 24 weeks 22 actual training/2 weeks final assessment Theoretical: 8 weeks/5 hour/day=200 hours Practical: 14 weeks/350 hours=100 credit hours THEORITICALS:
1. 2. 3. 4. 5. 6. 7.

8.
9. 10. 11. 12. 13.

Introduction to family Medicine: 10 hours Consultation Models: 20 hours Counseling in practice: 10 hours Diagnostic Methodology: 10 hours Prescribing Process/Therapeutics: 20 hours Ethics in practice: 10 hours Prevention: 20 hours Audit/QI: 15 hours Management of the practice: 10 hours Human and illness behavior: 15 hours Common problems in family medicine:20 hours Chronic diseases management: 20 hours Evidence-based family medicine: 15 hours

PRACTICALS:
1.

2.
3. 4. 5. 6. 7.

8.

Consultation: Counseling: Diagnostic process: Prescribing: Prevention: Audit: Management: EBFM :

100 hours 50 hour 20 hours 10 hours 50 hours 50 hours 50 hours 20 hours

CONSULTATION Consultation style Diagnostic style Ethics in practice Prescribing/ Therapeutic Human and illness behavior

COUNSELLING Counseling sessions Non-drug management Explanation and counseling Explanation skills Mutual Understanding

PREVENTION AUDIT

Concept and theory Primary prevention and roles Theory prevention and roles Tertiery prevention Evidence in prevention

Project Peer audit External audit Assessment EBFM 1. Tutorials 2. Journal Clubs

MANAGEMENT

Management in general Management of personnel Business Management Management of documents Health care system and framework in Saudi Arabia

ASSESMENT AND EVALUATION A) ASSESMENT A.1: On going assessment (Formative) Punctuality: Not less than 85% attendance Mini project: Audit Critical reading/Journal club: Not less than 3 written critique Chronic disease protocol Consultation map A.2: Final assessment (end-stage) MCQ= 50 Qs = 2 hours Problem solving=50 Qs =2 hours OSCE= 5 stations 2 viva (patient stations) 3 documents Vivavoc= one session (15 minutes) B) COURSE EVALUATION Trainers reports Trainee report Exam report (supervisors) External audit (if possible) Results to be announce within a month of exam completion. 1. INTRODUCTION TO FAMILY MEDICINE History of family medicine & general practice

 Family medicine in developed VS developing countries Family structure Curriculum of GP/FM in general On need for GP/FP Family med/ GP as a concept and independent medical discipline Experience from a developing country ALAMTA declaration and family Practitioner/GP 2. CONSULTATION MODELS 3. 4. Balint Model Byrn and long model Eric Byrne model STOT and Davis model Pendleton Model Roger Neighbor model Problem solving model Biomedical VS Biopsychosocial model Consultation teaching and learning Practicum COUNSELLING Importance The concept Egan style Practicum DIAGNOSTIC METHODS Principles of Hx taking Interviewing skills Deep probation skills Verbal & Non-Verbal communication skills Clinical examination skills

 5. 6. 7. 8.

Investigations necessary and unnecessary Practicum PRESCRIBING SKILLS Rationale The how method Poly pharmacy Traditional VS Generic Prescribing The format and Abbreviations Practicum ETHICS AND PRACTICE Patient/ Family autonomy and rights Doctors charter/Code of conduct Confidentiality Justice Micro and Macro allocation of resources Euthensia Collegiality among professionals Dr./PT relationship PREVENTION The concept The need/ Importance Primary prevention, examples Theory prevention, examples Tertiary prevention, examples Counseling for risk groups Prevention in practice/opportunities not to be missed Fallacies in prevention Practicum AUDIT/QI Audit Definition

 care 9.

QI Definition International/National Standards for primary health Peer audit/Self audit/External audit Accreditation process preparation Practicum (Mini project) MANAGEMENT IN PRACTICE Team management Team work concept & principles Paper and documentation management Confidentiality Insurance and finance management Practicum

10.HUMAN AND ILLNESS BEHAVIOR 11. Human behavior in health and disease Clinical presentation to PHC clinics Illness behavior Hidden agenda Games people play Bereavement reaction Breaking bad news Practicum COMMON PROBLEMS IN FP/GP Depression Bronchial asthma Sore throat/ Pharyngitis/Tansilitis Dyspepsia Red eye Back pain Joint pain Basic Life support & live saving

 12.

Earache Dizziness Fatigue Headache Some child problems Some women problem CHRONIC DISEASE MANAGEMENT General Specific 1. Liver disease 2. Bronchial asthma 3. Diabetes 4. Hypertension 5. CHD risk management 6. Psoriasis Practicum= Protocol EVIDENCE- BASED FAMILY PRACTICE

13.

Evidence based theory & concept Evidence based practice Examples of evidence based practice in family practice Critical reading and thinking Practicum=Critical reading/journal clubs

APPENDIX
FAMILY PHYSICIAS WITH no FRONTIER SOCIETY Family Medicine Development Program FRAMEWORK For Professional and Administrative Development Of General Practice/Family Medicine

Prepared by: Prof. Samir Y. Mossa, MD, Ph.D., MRCGP,FAAFP,MIC Professor in Family Medicine 2006

Introduction: In recent years, many countries worldwide have embarked on reforms of their health systems, either as a part of broad political changes or as specific policies to improve their health services. Reform of primary health care has been a feature of this movement in several countries, often involving the reorganization of existing systems of general practice or their introduction where non-existed. The WHO Regional offices worldwide, convinced of the potential contribution of general practice/Family Medicine to health for all, through the delivery of a wide range of integrated health care functions including health promotion, disease prevention, curative, rehabilitative and supportive care. Egypt is one of the leaders among the Arab countries in the field of health care delivery with big numbers of medical schools and a comprehensive system for health care delivery, recently it develops a revolution to reform its health care delivery system and physicians professional careers through the ministerial decree for formulation of High Committee of Medical Specialties in MOHP. The Egyptian Of Medical Specialties is in fact an outstanding developmental strategy of the MOHP which demonstrates practical approach towards the upgrading of skills of Egyptian physicians. Family Medicine is the most recent strategy for specialization in Primary Health Care (PHC). It is the specialty that deals primarily, comprehensively, continuously with the health service consumers on all individual, familial and communal health basis, always providing the basic benefit of health care package in an integrated and continuous form. The Egyptian Board of Family Practice (EBFP) is to fulfill the need for physicians specialized in PHC delivery within the local and

regional cultural, social, economic and environmental framework Purpose of the Document: The need to orient health care systems towards primary health care has been re-affirmed on several occasions.
2.

While the organization and functions of primary health care differ from one country to another because of historical developments and different social, economic and cultural circumstances, the services provided by General/Family practitioners constitute an essential element of primary health care irrespective of whether they work in single practices or in partnership with other general practitioners, (on their own or as part of a team of health professionals). And as the main provider of first contact care or as one of several specialists to which the population has direct access, (their role in providing integrated health promotion, disease prevention, curative, rehabilitative and supportive care is recognized in many countries). Without ignoring the contribution of other medical specialists and other health professions, it is widely accepted that general practice/Family Medicine has the potential to contribute in offering: @)Accessible and acceptable services for patients @)Equitable distribution of health care resources @)Integrated and coordinated delivery of comprehensive curative, rehabilitative, palliative and preventive services and health promotion. @)Rational use of secondary, tertiary care technology and drugs. @)Cost effectiveness either explicit, immediate or hidden cost.

General Practice/Family Medicine can thus contribute to an effective and efficient primary health care service of high quality, Which should positively affect the workload and quality of specialized and hospital care. The purpose of this document is to explain and promote the essential role of general practice/Family Medicine as a specialty in its own and of General/Family practitioners as specialists in contributing to improve the health of individuals and groups. In this document, given the differences in the way these terms are used and interpreted worldwide refer to the medical specialists, in the discipline of general practice or Family Medicine. Correspondingly, the terms general practice and Family Medicine and the terms general practitioners and Family Physician are used as being equivalent. This document has been established and developed with an appreciation of the varied nature of the systems currently operated and the problems faced by many countries before. It is designed to apply to those countries that are in the early stage in the implementation of education and training programs to provide a first generation of family physicians, and those with established systems of general practice that could be improved and strengthened. It recognizes that general practice can be elaborates and organized in a variety of ways, depending on the countrys circumstances, resources and traditions. The document is addressed to all parties involved in health care: decision makers at different levels, those responsible for resources allocation, planners and managers, academic institutions, unions organizations of family physicians, health professionals, and patients and their representatives.

The successful development of Family Medicine requires not simply the willingness but the wholehearted commitment of all those persons and bodies. Such commitment must be long-term and combined with willingness to respond flexibly and positively to problems as they arise. Legislation, regulations, recommendations and guidelines should be developed. Financing and payment systems that support the development of Family Medicine may have to be introduced. Programs of research, Quality development, Vocational Training and Continuing Medical Education have to be developed or adapted, and family Physicians may have to be trained or re-trained. 3.Characteristics of General Practice/ Family Medicine Although some of these characteristics are also applicable to other medical specialties, they are considered of particular relevance to family Medicine/General Practice. They are described as following: 3.1General: General practice/Family Medicine addresses the unselected, unconnected and undifferentiated health problems of the whole population; it dose not exclude certain categories of the population because of age, gender, social class, race or religion, or any category of complaint or health related problems. It must be easily accessible with a minimum delay; access to it is not limited by geographical, cultural, administrative or financial barriers. 3.2Continuous: Family Medicine is primarily person centered rather than disease centered. It is based on a long standing personal relationship between the patient and the doctor, covering individuals health care longitudinally over substantial periods of

their life and not being limited to one particular episode of an illness. 3.3Comprehensive: Family Medicine provides integrated health promotion, disease prevention, curative, rehabilitative and supportive care to individuals from the physical, psychological and social perspectives. It deals with the interface between illness and disease and integrates the humanistic and ethical aspects of doctor-patient relationship with clinical decision-making. 3.4Coordinated: Family Medicine can deal with many of the health problems presented by individuals at their first contact with their family physician, but wherever necessary, the family physician should ensure appropriate and timely referral of the patient to specialist services or to another health professional. On these occasions, family physicians should inform patients about available services and how best to choose them and should be the coordinators of the advice and support those patients received. They should act as care managers in relation to other health and social care providers, advising their patients on health matters. 3.5Collaborative: Family Physicians should be prepared to work with other medical, health and social care providers, delegating to them the care of their patients whenever appropriate with due regard to the competence of other disciplines (They should contribute to and actively participate in a well functioning multidisciplinary team and must be prepared to exercise leadership of the team).

3.6 Family- oriented: Family Medicine addresses the health problems of individuals in the context of their family circumstances, their social and cultural net- work and the circumstances, in which they live and work. 3.7Community-oriented The patients problems should be seen in the context of his/her life in the local community. The Family Physician should be aware of the health needs of the population living in this community and should collaborate with other professionals and agencies from other sectors to initiate positive changes in local health problems. 4.Conditions for the development of Family Medicine in Egypt. 4.1.Defined Population: The provision of ideal General Practice/Family Medicine is encouraged by continuing relationship between the family physician and his/her patients and the continuity of care over the time are facilitated when family physicians look after a well defined group of people (catchment geographical areas). Having a specific family physician does not contradict the basic right of the patients to choose their doctor, or to change from one doctor to another. So, we have to define the catchment area for every health center with a defined number of families or persons with avoiding duplication of registration.

4.2.Serving the General Population: Family physicians must be trained to deal with the health problems of all population groups, including children, men, women and the elderly, without distinction providing integrated care to the population is enhanced by modifying the fragmented services among different specialties and agencies, as the existing case in EGYPT that deliver care to certain categories of patient or of the defined population (e.g. School Health, Preventive Services, MCH, etc.). 4.3.Working environment: Family Medicine is based in the community, close to the patients, with easy access by them. So team approach to be enforced, job descriptions to be developed for each member of the health care team, Medical Guidelines to be implemented and avoid injuring the personal care nature or reducing the accessibility of the health care wherever the benefit to the patient or families could be obtained. 4.4. Referral System: The coordinating role of family physicians is best carried out when their training (either by vocational training programs or by re-orienting CME programs for existing practitioners available in health centers in EGYPT or by recruiting some physicians who have received such sort of training) provides them with the knowledge and skills required to manage the majority of the unselected cases that present to them and to refer appropriate cases to other health care providers, either within primary health care (intra-practice referral) or to secondary specialized care and hospital based services. Cost-effective use of Secondary Care Services is best achieved when only those cases that actually warrant these services are referred to them.

Successful implementation of a referral system requires its acceptance by patients, which can be achieved by fostering their trust in the family physician. It also requires good cooperation, exchange of information and reciprocity between family physicians and other medical specialists and health professionals; Family Physicians must make appropriate referrals, and information must be fed-back to them from concerned specialists and consultants, patients must also be similarly refereed back to their family physicians in health centers with report or a letter about what happened to them in the hospital or out-patient clinic of the concerned specialty. 4.5.Incentive System: To avoid slow change in our existing system, health planners and executives should develop an appropriate incentive system to motivate such ensthiastic health care professionals either financially or appreciation or promotions or any other way they feel it can help to develop internal locus of control and spirit among those who do well and trying to modify the attitude of those who resist change. 5.Keeping patient records: Systematically keeping detailed problem-oriented and complete records of all encounters is important to maintain continuity over time, to identify episodes of illness, to create a patient history and to coordinate care where several providers of care are involved. Their cards should also include other information relevant to patients care for example on matters relating to their living and working conditions and their life styles. Systematic preventive procedures and assessment of health needs of the population are impossible without a sound record system that enables patients, groups at risk to be identified.

Finally, records are an essential requirement for quality development, audit of care, peer review, etc. The confidentiality of the information must be preserved in accordance with existing legislation. Patients have the right to access their own record, and information may only withheld from them only when it reasonably appears that it would cause them serious harm, that is why the medical record existing system in health centers should be revised, updated and reformed. 5.1.Teamwork: Coordination in health care requires family physician to have a knowledge about the training of other health professionals and their job description and an understanding of what and how they can contribute to the work of other health care providers, this area of major concern as different accountability and loyalties made the existing health care system is not coordinated and towards different objectives and goals. Teamwork when enforced makes it easier to pool the skills and expertise of a number of health and social care professionals and enhances the reputation of Family Medicine. 5.2. Health centers organization: Family physicians need adequate premises (Which is existed but some of them need renovation), equipment (Which need reconsideration and inventory check lists to be developed according to international standards) and ancillary staff (also an area for reconsideration and finding a way to develop a skill mix pattern by retraining either in service or outside the health centers, the family physicians can contribute in re-skilling and training of those professionals).

The premises should respect the privacy of patients, provide opportunities for diagnosis and treatment and facilitate accessibility. Whatever the structure of health center, the organization should be flexible, which among other things means providing direct help for emergency cases, an appointment system for patients with less urgent problems and sometimes have care, wherever appropriate. Supporting services such as x-ray and Lab. Facilities must be accessible to family Physicians, either under the same roof (in the center or with special arrangement with these facilities in the hospital). Defined working hours and services available should be clear for patients and health professionals; also what are the services available during closure of health centers (out-of-work hours) 6.Professional Development: 6.1.Education (Academic Family Medicine) All health professionals and medical specialists working in primary health care must receive undergraduate, postgraduate and continuing education on the concepts and specific content of primary health care. As our existing primary care system still in the first steps, some arrangement should be taken to recruit people with appropriate experience and to retrain other people who are willing to receive such training programs and recognize them after that as primary health care members (e.g. PHC physicians, PHC dentists, PHC nurses, PHC receptionists, PHC social workeretc.). Education for Family Medicine/General Practice can usefully be considered under three major headings:

atraining:

Undergraduate basic medical

All medical students should be exposed to Family Medicine, so that they acquire knowledge that is specific to this discipline and gain a requisite understanding of the need for cooperation among all sectors of the health care system therefore, the new applicant for the training programs should submit a document about that and the selection exam and interview to include questions about this pre requisite (this might be negotiated with the Universities authorities and steps should be taken to develop either departments for family medicine or to be as subsections within the community medicine departments). b. training: Postgraduate vocational

Must be a requirement to become a family physician. This vocational training should be equivalent to that of other main clinical specialties and should be primary health care-oriented and based-to a considerable extent- on general practice. Health centers, possibly affiliated with academic departments, should have a prominent role in teaching (as in training centers in the defined governorates). The vocational training existing (Egyptian Board Residency Program) is a good start but thinking about local or international programs should be encouraged. The existing curriculum (after modification) is quite sufficient for other programs to recognize the training program. e.g. MRCGP Int., (UK), MICGP (Ireland), Arab Board .etc.

D. For updating skills and maintaining and improving the quality of care, continuing medical education (CME) and continuing professional development (CPD) are mandatory. CME programs must be Family Medicine-oriented and based on research, in particular primary health care. The Prime Responsibility for CME rests with the medical practitioners themselves, who will need to use different modalities to achieve and maintain their competence. Distance Learning Techniques may be of great benefit to facilitate access to training by doctors 6.2. Quality Development: Family Medicine/General Practice should be open to evaluation. Quality assessment and development is essential in continuing medical education and can be an important instrument in quality assurance. Systems of clinical audit organized by doctors themselves and carried out in peer groups are effective. Agreed professional guidelines are important tools for professional development. EGYPTIAN primary health care project needs a full system in quality assurance and development which must congruent with Hospital System but with different tools of execution as long as both situations are different in context and applications. 6.3.Academic Family Medicine/General Practice: As long as Egyptian Medical Schools have few defined departments for family medicine, for the health care and universities authorities, given the specific characteristics of General practice/Family Medicine as a specialty, its

recognition as an academic discipline is essential to the acceptance of family Medicine as a full partner in the provision of health care.

Considering those candidates who are graduated or still in the training program as a nucleus for the faculty of the potential academic Family Medicine Department, this department should be provided with sufficient resources, must be headed by practicing family physicians or persons with a solid background in Family Medicine and appropriate academic credibility. 6.4. Research: Academic departments and training programs in Family Medicine should concentrate not only on training and education but also on research. Vocational training programmes should make future family Physicians research-minded. There should be opportunities for trainees to carryout research during their training. Family Medicine research should be fully funded and closely related to health problems that family physicians care for and to the clinical activities that they carry out in their daily work. 6.5. Professional Organization: It is clearly apparent that Family Medicine/General Practice has been for a long time ignored on the level of decision-making process. The profession of Family Medicine clearly needs an effective organization to identify professional needs and promote professional development at national level and to support local initiatives. Family Physicians must be represented at the highest levels in all the relevant medical decision-making bodies in Ministry of Health and Egyptian Board for health specialties.

7. Strategies for the development of Family Medicine/General Practice 7.1. The starting point: As we are in EGYPT, just started to implement the Family Medicine discipline, some indications are useful of how and where to start implementing the recommendations contained in this document. Some of the conditions are easier to implement than the others. One important stage in the process is to gain the broad support and cooperation of the health professions, administrators and health authorities. This will prepare the ground, through information and education, for wide acceptance by the population of the special role of Family Medicine. Family Physicians themselves and their organizations (Egyptian Society of Family Medicine) should play a significant role in doing this. 7.2. Opportunities from within the profession: Establishment of an association for improving the position of family physicians (Family Med. Depts. Either in universities and MOHP). A good academic training program (now Egyptian Board residency program) for promoting the content and the quality of their professional activities. Developing a clear curriculum appropriate to our circumstances in EGYPT and according to the true health needs of the population.

The process of introducing Family Medicine is also facilitated through contacts with countries where it has a long-standing tradition and experience in Family Medicine field (e.g. Bahrain,Saudi Arabia,Omanetc).

International Collaboration for the development of Family Medicine, while respecting local culture and traditions in EGYPT contributes to progress by enabling people to learn from the experience of others (e.g. UK system and fellowship assisting program with international committee of RCGP should be considered). 7.3. The Role of Decision Makers: Without support from outside the profession (which in its early beginning), it may be difficult to develop Family Medicine. In order to meet various conditions mentioned early in this document (such as the provision of integrated, wellcoordinated services), the active support of policy and decision-makers, politicians and general public is needed. Policy and decision-makers should be sensitive to valid claims of cost-effectiveness, politicians and general public to those of equitable, accessible and comprehensive care. The implementation of Family Medicine/General Practice System in EGYPT requires supportive legislation and regulations. The current attitude of the population in EGYPT where by quality of care is associated with highly specialized and high tech. Services will be only changed by demonstration of quality in Family Medicine/General Practice. Lastly:

It seems more feasible not to start with a large-scale operation. The training of Family Physicians takes time; Furthermore, carrying out a pilot project (e.g. small numbers of health centers) prior to full implementation of a programme will provide an opportunity to correct mistakes without long-term consequences.

Conclusion: The community and hospital care should be the two pillars of Health Care Provision in EGYPT. As long as evidence by research and experience have been accumulated that Family Medicine deals with 90% of health care problems, so Family Medicine should be a vehicle for community health care in EGYPT. It is clearly apparent, that implementing the General Practice/Family Medicine system will reduce the cost of health care delivered and proven cost-effective. The need for qualified Egyptian Family Physician who is well trained appears mandatory for the future of Egyptian Community. Rearranging of the public attitude and beliefs towards health care delivery and family physicians appears mandatory through the Press and the Media.