Family Medicine Specialty Research Articles

Awareness and Utilization of ROME Criteria for Diagnosis of Inflammatory Bowel Syndrome among Primary Care Physicians in Riyadh, Saudi Arabia.

Introduction:Irritable bowel syndrome (IBS) accounts for a reasonable number of medical encounters in primary care, yet a large proportion of cases remain undiagnosed or misdiagnosed due to non-application of systematic approach in such cases.Aim:We aimed to assess the awareness, attitude and self-reported utilization of ROME criteria among primary care physicians.Methods:A cross sectional study was conducted among primary care physicians under ministry of health, Riyadh, Saudi Arabia (N=216). A pre-designed, structured, closed ended, self-administered questionnaire was used to collect the data. SPSS 20 was used for data analysis.Results:A great majority of physicians (about 86%) were aware about ROME criteria; about 57% were having detailed knowledge, while about 53% considered themselves skilled enough to use it confidently. Only 29% physicians reported to use it frequently in their day to day practice. Knowledge, attitude and practice were found to be significantly higher among family medicine specialty as compared to others (p<0.05), whereas knowledge and attitude were noted to be significantly higher among residents as compared to specialist (p<0.05). No association was noted with age, gender, nationality and duration of clinical experience (p>0.05).Conclusion:We found a low utilization of ROME criteria among physicians with remarkable gap between awareness and practice.

Previous Involvement in Research and Knowledge Regarding Basic Research Methods Among Doctors Working at Primary Care in Central Region, Saudi Arabia.

Introduction:The cumulative outcomes of health research in the modern times had a huge effect on human health and longevity. The primary care physicians are the first point of contact between the health system and the society. Therefore their responsibility is higher to provide the latest information to their patients, in the context of rapidly changing field of medical science. Doctors are expected to have a basic knowledge of research methodology in order to develop a critical thinking and this is the rationale to include the research activity is an integral part of post-graduate medical training.Aim:We aimed to assess the previous involvement in research activities and knowledge in basic research methods among primary care physicians in central region, Saudi Arabia.Methods:It was a cross sectional descriptive study conducted on a conveniently selected sample of doctors (N=80) working under general directorate of health affairs in Riyadh region, Ministry of Health. The data was collected through a pre-designed, self-administered survey instrument containing closed ended questions.Results:The mean age of the physicians was observed to be 44.7 ± 9.6 years. About 32% doctors had previous experience of writing a research proposal while only 20% had any publication in a scientific journal. About 45% had attended workshop on research methodology within last five years. Only one item related to ‘consent in medical research’ was answered correctly by 60% respondents. The correct responses in other knowledge items scored less than 50% (ranging from 18.8% to 37.5%). The proportion of doctors having any publication was observed to significantly higher among younger age (p<0.05). Significantly higher proportion was observed for “having experience of proposal writing” and “paper presentation in a scientific conference” among family medicine and other specialties as compared to general practice (p<0.05).Conclusion:We found low previous engagement with research among doctors with low level of knowledge regarding basic research methods. This was particularly evident among general practitioners as compared specialist doctors. Regular conduction of research workshop with encouragement to undertake small research activities at the primary care should be promoted.

How clinician examiners compare with simulated patients in assessing medical student empathy in a clinical exam setting

Background: Empathy is an important clinical attribute to be assessed during clinical examinations. While simulated patients (SPs) are well positioned to assess empathy in such settings, clinician-examiners are objective observers who are also experts in assessment. In this study, the assessments of student empathy from both examiners and SPs in clinical examinations were compared.Methods: The 10-item CARE measure were used for the assessment of empathy in 158 medical students in the Family Medicine specialty clerkship clinical competency test. The ratings from examiners and SPs were analyzed together with genders of students, examiners and patients, and the examination results.Results: SPs empathy ratings were higher than those from examiners across all ten items of CARE. A weak positive correlation was found between both ratings. Female SPs were more likely to give higher ratings, and examiners were more likely to give higher ratings to female students. SPs rating was moderately correlated with student examination score, while the correlation with examiners rating was strong.Conclusion: Although the inter-rater reliability was weak between the empathy rating from simulated patients and examiners, the evaluation of empathy from the patient’s perspective was seen to be more authentic as they are in interaction with the students.

Finding and fueling your professional passion.

Burnout among physician faculty in academic family medicine and other specialties has been measured at “epidemic” levels. No parallel research has been completed on behavioral science faculty in family medicine. Behavioral science faculty face many of the same stressors as their physician colleagues and have a high potential for professional isolation. Therefore, it seems likely that burnout is an issue for behaviorists, as well. This paper will describe the stressors that behaviorists in family medicine may face and briefly reviews some of the literature on burnout in physicians. The potential roles of meaning making, professional affiliation with one’s “discipline of origin,” and of engaging in a “passion project” are reviewed. The author shares experiences with these strategies and highlights how a “passion project” can facilitate engagement and meaning making even under challenging circumstances. In addition, she reviews the opportunities and challenges inherent in increased engagement, focusing on timing, peer support, and subject matter factors that should be considered before undertaking any major project. After reviewing Vallerand’s work on “harmonious” versus “”obsessive” passion, the author notes how behaviorists can monitor their own level of career engagement and ensure that their passion projects remain a source of “harmonious” passion.

The Family Medicine Attitudes Questionnaire: A Valid Instrument to Assess Student Attitudes Toward Family Medicine.

Medical student attitudes toward family medicine influence student likelihood of choosing family medicine and the US primary care physician workforce. We sought to refine and assess the validity of the Family Medicine Attitudes Questionnaire, an instrument that assesses student attitudes toward family medicine in US medical students. A 24-item questionnaire, including items assessing students' attitudes toward family medicine's importance, family physician shortage, family medicine research, family systems, family physicians' expertise, and lifestyle, was offered to fourth-year students at 16 US medical schools. We evaluated the questionnaire's content validity, construct validity, and criterion validity. Content validity was assessed using a qualitative approach to direct observation, construct validity by data reduction and iterative factor analyses, and criterion validity by correlating items with intention to match into family medicine. The questionnaire was completed by 1,188 (44.9%) of 2,644 students invited to complete it; 10 items were removed in the validation process. The final 14-item instrument had a Cronbach α of 0.767. Total score correlated with family medicine specialty choice (P&lt;.001). A questionnaire score of 56 or higher is 78.1% sensitive and 65.3% specific for identifying students who intend to match into family medicine. In regression analysis, questionnaire score was an independent predictor of choosing family medicine (odds ratio 1.289, confidence interval 1.223-1.347). The Family Medicine Attitudes Questionnaire is a valid instrument for assessing US medical student attitudes toward family medicine. This tool will help educators assess the impact of curricular and policy interventions designed to promote family medicine specialty choice.

The regional medical campus model and rural family medicine practice in British Columbia: a retrospective longitudinal cohort study.

Regional medical campuses have been implemented across North America to address gaps in the physician workforce. We report findings from a study that examined the association between a combined model of regional medical campuses and students' decision to enter rural family medicine practice. In 2004, the University of British Columbia added 2 regional medical campuses, 1 in a large population centre in a rural and coastal context and 1 in a medium-sized population centre in an isolated northern and rural context. Data were extracted from the University of British Columbia's Medical Education Database. Multivariable logistic regression examined the relationship of age, sex, rural background and campus location to students' choice of rural family medicine practice. There was an association between campus location and choice of family medicine versus other specialties. A rural background (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.08-6.21) and training at either of the 2 regional medical campuses (OR 3.24, 95% CI 1.19-8.83 and OR 5.38, 95% CI 2.24-12.91) predicted rural family practice. Choosing to practise family medicine in a rural location was associated with having a rural background and having trained at a regional medical campus. These early results suggest that a combined regional campus model in medical education contributes to the rural family practice workforce.

Graduating Medical Student Perspectives on Factors Influencing Specialty Choice An AAFP National Survey.

Fewer than 10% of US medical school graduates enter family medicine residencies each year. Little is known about the perceptions and attitudes of senior medical students as they make final decisions about specialty choice, especially those that support a decision to pursue family medicine. The American Academy of Family Physicians (AAFP) administered a national survey to US seniors in 2015 to explore these factors. US seniors who were AAFP members (N=11,998) were invited to complete a survey exploring attitudes toward family medicine and experiences that influenced interest and choice of family medicine (FM) or other specialties. This was offered after students submitted their National Residency Matching Program rank list but before match. For those matching in family medicine, additional questions explored mentorship experience. Factors significantly predicting intent to match in family medicine, mentor attributes significantly influencing student attitudes, and family medicine interest group (FMIG) participation were identified via regression. The survey response rate was 15.1%. Student perceptions of the respect of FM (OR=0.82), the future of FM (OR=2.04), and FMIG involvement (OR=1.75) predicted choosing FM, as did AAFP student membership (OR=2.13-2.44) and AAFP National Conference of Family Medicine Residents and Students attendance (OR=9.77). For students entering FM, having supportive mentors outside of FM and being dedicated to FM positively influenced their attitudes toward FM and their FMIG participation. National programs, FMIGs, mentorship, and medical school support of family medicine play a role in student selection of family medicine.

Perception, attitude, and satisfaction of the public from family medicine in Saudi Arabia

Background: Family medicine is the restorative claim to fame that gives proceeding with, extensive social insurance for the individual and family. It is a claim to fame in broadness that incorporates the organic, clinical, and conducts sciences. The objective of this study was to assess the awareness and knowledge of family medicine physician and his/her practice among the general population of the Kingdom of Saudi Arabia. Methodology: A cross-sectional study was carried out and random, representative samples from male and female Saudi nationals belonging to different age groups were collected for the study. The study was conducted during the period from 1 June to 31 August 2018. Data was collected using a pre-designed online questionnaire. Results: According to the knowledge of the studied population about the family medicine specialty and the role of the family medicine specialist, our study reported that, 86% of cases had heard about family doctor, 37.5% visited family doctor and 61.1% know that the family doctor has a role in treating many of the health problems experienced by family members, especially clinical and surgical diseases, such as respiratory diseases, urinary system, and skin diseases. A 73.6% of them were found to know that the family doctor has a role in referral of the patients to the needed specialist in the case of the inability to treatment, 71.3% know that the family doctor has a role in follow up the patients' condition, and all the changes that occur, 63% know that the family doctor has a role in the early detection of any disease threatening society, 69.7% know that the family doctor has a role in keeping records for each patient, which records his/her health status, and medical history, 60.8% know that a family doctor has a coordinating role in working with a physiotherapist, nursing staff, and psychiatrists, 70.4% know that the family doctor has a role in protecting family members from various diseases, by providing them with the necessary vaccinations, clinical examination, and some essential investigations, such as cholesterol level, cancer screening, and blood picture and 69.8% know that a family doctor has a role in the treatment of chronic diseases, such as asthma, diabetes, hypertension, and heart disease. Conclusion: The present study results showed that the Saudi Arabian population has knowledge of useful information about the family medicine specialty and there is proper utilization of the service.

Prevention in primary care – intrafamilial predictive model (IPM)

The essence of the family medicine specialty remains surveillance of the health for the whole family: from pregnancy to child, from young to senior, from health to disease, from preventive to therapeutic interventions. The family doctor (GP) carries on two or even three generations of the same family, comes in contact with each family member, during many years of medical practice. The continuous clinical monitoring, will allow preparation of a “Risk Factors Map” (RFM). RFM is based on the high risk chronical pathology faced by a family over generations. Analyzing RFM and identifying major risk factors that act inside the family, GP can generate an intrafamilial predictive model (IPM). Having under medical care the whole family, developing in time a relationship of trust with the patients, based on serious professional training, armed with good communication skills, GP has the possibility to implement personalized educational interventions inside the family for life style changing. This kind of intervention applied in early childhood, can slow down or delay the appearance and the evolution of the severe chronical diseases. In essence, IPM is an early preventive interventional mechanism in controlling the occurrence of major chronic diseases in future adults.

Referral Patterns for Dual-Energy Computed Tomography in Diagnosis and Management of Gout: Ten-Year Experience at a Canadian Institution

PurposeTo analyze the utilization, indications, and outcomes of dual-energy computed tomography (DECT) gout imaging in clinical practice. MethodsThis retrospective study was ethics approved. Radiology reports of DECT gout scans between 2007 and 2016 were analyzed for trends of utilization, referral pattern, indication, and diagnosis. ResultsDECT gout referrals increased substantially (2007: 37; 2008: 72; 2016: 385; total: 1877). The largest number of referrals were from rheumatology (1160), emergency medicine (283), and family medicine (177). Most referrals (92%) were requested to aid an initial diagnosis of gout. Other reasons included estimating the disease burden (6%) or monitoring disease progression and effectiveness of treatment (2%). Rheumatology accounted for most referrals for the latter two reasons (81% and 97%). Imaging findings of urate presence were similar in referrals from rheumatology (62%), family medicine (62%), and other medical specialties (62%). The urate positive rates were slightly lower in referrals from emergency medicine (47%) and surgical specialties (41%). The most common differential diagnoses by referring specialties were calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and other inflammatory or erosive arthritides (rheumatology, family medicine), CPPD and infections (other medical specialties), infections and fractures (emergency medicine), neoplasm and infections (surgical specialties). ConclusionsThe increasing utilization of DECT for gout imaging validates its clinical value. Varying clinical presentation could explain differences of urate positive rates among specialties. Our results support a multispecialty collaborative approach to the diagnosis and management of gout, with direct access to DECT gout imaging provided to various physician specialties.

Náuseas no Natal: o papel do médico de família no diagnóstico de doença grave

Introduction: The family physician (FP) is often the patient’s first contact with health system, dealing with diseases in early stages when symptoms are still nonspecific. With this case report, we intend to promote the reflection about the role of FP in the several stages of the process of diagnosis, and about the characteristics intrinsic to general and family medicine specialty that facilitate it. Case report: We present the case of a 48-years-old female, integrating a reconstructed family of medium socioeconomic status, with history of depressive syndrome (medicated with fluoxetine), in climacteric. She presented with nausea, bloating, and generalized pruritus for the last 10-days and a single vomit on Christmas Eve. The physical examination revealed mild abdominal pain in the epigastrium. She was prescribed according her symptoms and ordered blood tests and an abdominal ultrasound. The patient returned 3 days later with scleral icterus and acholic stools, maintaining nausea. No choluria or fever were present. Complementary diagnostic tests showed conjugated hyperbilirubinemia; ultrasound revealed pronounced dilation of the common bile duct, a nodular image in the pancreatic body/tail and multiple adenopatic conglomerates. The patient had no evident consumptive symptoms. Abdominal computed tomography revealed an adenopatic conglomerate implicating the pancreatic head, most likely to be associated with a lymphoproliferative disorder. Patient was urgently referred to the Hematology-Oncology consultation where the final diagnosis was established: non- Hodgkin’s diffuse large B cell lymphoma. She completed 8 sessions of chemotherapy and is currently under remission. Comment: Although the FP’s decision-making process is mainly based on the community epidemiology of diseases and patient’s sociocultural context, the diversity of diagnostic hypothesis that may result from the natural course of disease can’t be forgotten nor underestimated. The FP should rely on the advantages of health care continuity and accessibility, thus enhancing his diagnostic role.

Saudi University Students’ Awareness and Attitude towards Family Medicine Specialty

Saudi University Students’ Awareness and Attitude towards Family Medicine Specialty

Institutional NIH Research Funding and a Culture of Support for Family Medicine-Their Relationship to Family Medicine Specialty Choice.

The United States suffers from a low proportion of medical students pursuing family medicine (FM). Our objective was to examine institutional characteristics consistent with a focus on National Institutes of Health (NIH) research, institutional support for FM education, and the proportion of medical students choosing FM. The 2015 CERA Survey of Family Medicine Clerkship Directors was merged with institutional NIH funding data from 2014 and medical student specialty choice in 2015. Institutional educational support was operationalized as (1) clerkship director's perception of medical school environment toward FM, and (2) amount of negative comments about FM made by faculty in other departments. The outcome was the percentage of students selecting FM. Bivariate statistics were computed. As NIH funding increases, the proportion of students entering FM decreases (r=-.22). Institutions with higher NIH funding had lower clerkship director perceptions of medical school support toward FM (r=-.38). Among private institutions, the negative correlation between NIH funding and the proportion of students entering FM strengthens to r=-.48, P=.001. As perceptions of support for FM increase, the proportion of students entering FM increase (r=.47). Among private schools, perceptions of support toward family medicine was strongly positively correlated with the proportion of students entering FM (r=.72, P=.001). Higher institutional NIH funding is associated with less support for FM and lower proportions of students choosing FM. These issues appear to be even more influential in private medical schools. Understanding how to integrate the goals of NIH-level research and increasing primary care workforce so that both can be achieved is the next challenge.

The Process of Family Medicine Specialty Training and Points to be Improved

Aile hekimliği uzmanlığı, birinci basamak yönelimli bir uzmanlık dalı olarak 1983 yılında tababet uzmanlık tüzüğüne girmiş ve ayrı bir disiplin olarak tanımlanmıştır. Uzmanlık eğitiminin, klinik uygulaması olarak öngörülen 18 aylık saha eğitimlerin aile sağlığı merkezlerinde yürütülmesi önem taşımaktadır ve mevzuatın bu açıdan gözden geçirilmesi gerekir. Bu yazı ile uygulamanın yaygınlaştırılması için çözüm önerilerinin tartışılması amaçlanmaktadır.

The failure of the family medicine gatekeeping role in Romania

The gatekeeper role is a mechanism for regulating access to medical services, through which the family doctor authorise the access to specialist consultations, investigations and hospital care. Medical services have ascending costs, so health systems try to find solutions to avoid healthcare spending. The role is not inherent to the family medicine specialty, but is delegated by health policy. The question is whether the family doctor should be a gatekeeper, a patient care coordinator or a counselor? This year marks the 40th anniversary of the Alma-Ata Declaration, when formal primary care was born as a concept. It is interes­ting to see what has happened in the meantime in Romania, how evolved or involuted, whether we have some­thing to do or everything is on the right track.

Workplace-based assessment of family medicine competencies using "field note tool" - A pilot study.

Background:Department of Family Medicine in a medical college in South India introduced “field note” (FN) as a tool for Work-Place Based Assessment in postgraduate training. FN collects “open-ended” feedback from both resident and faculty and helps them to arrive at an action plan. This study describes our experience of implementing FN and perceptions of learners and faculty.Methods:While precepting the residents in Family Medicine service areas, faculty documented their observations of the resident's clinical work using FN and provided an action plan. Faculty and residents described their experience and provided feedback. Focus group discussions were conducted for faculty and residents. Data were coded and grouped into themes.Results:Four residents and seven faculties participated in the study during 12 weeks period using 17 consultations. Clinical expert (13/17) and communicator (6/17) are the most commonly assessed competencies followed by professionalism (2/17) and collaborator (2/17). Faculty and residents agreed that “FN” was a useful tool and it helped the faculty to give feedback and guide the learner. Residents and faculty arrived at an action plan in 70% of the consultations. Three of four residents perceived the change in their behaviour positively after the use of FN. Both resident and faculty found the rating of the learner using Dreyfus scale as a barrier.Conclusion:FN could be one of the important tools in our “Toolbox of Assessment Methods” for family medicine specialty. There is a need for sensitizing the learners to feedback process and training the faculty in assessment and feedback.

Evolution of family medicine residency training program in Dubai Health Authority: A 24-year review, challenges, and outcomes.

Introduction:It is well known that family medicine (FM) is a cornerstone for developing a community-based health-care system, and training family physicians is critical for the society. In Middle East, only 5%–10% of physicians, nurses, and health technicians are citizens. This demands more efforts toward having national FM practitioners in the country. The development of FM residency training program through the past two decades in Dubai has played a crucial rule in this aspect.Methods:The primary purpose of this study is to review the status of FM specialty training in the Emirates of Dubai throughout the past two decades.Results:The FM residency training program started since 1993 and had intake of 230 residents till 2017; out of which, 200 (87%) were female and 211 (92%) were the United Arab Emirates national. From 176 residents who are supposed to be graduated by 2017, 162 (92%) completed 4-year training, 132 (75%) has got the Arab Board certificate, and 116 (66%) qualified by the Membership of the Royal College of General Practitioners (MRCGP) international.Conclusion:The present study revealed that despite all challenges, the well-structured FM program enabled the graduates to reach high clinical, administrative, leadership, and academic positions such as consultant (40), chief executive officer (1), chief advisor for primary care (1), director (9), head of sections (9), head/deputy head of primary health center (55), head of academic affair center (1), chair of MRCGP international (1), program director of FM (4), MRCGP convener (6), MRCGP coordinator (6), and MRCGP examiner (42). However, the program is still lacking certification by an international accreditation body. This will help in reaching a better balance between education and clinical duties for all trainers and faculty; and will positively advocate support for an environment conducive to learning for residents as well as faculty members.

Associations among medication regimen complexity, medical specialty, and medication possession ratio in newly diagnosed hypertensive patients: A population-based study.

The aim of this study was to explore the associations among the medication regimen complexity index (MRCI), medical specialty, and medication possession ratio (MPR) in newly diagnosed hypertensive patients.Data from 19,859 newly diagnosed hypertensive patients were collected from 2,000,000 random samples of the National Health Insurance Research Database in Taiwan. All study participants were followed for 1 year after the first diagnosis of hypertension. MPR was defined as total days of antihypertensive drugs supplied/365 days. MRCI was calculated on the basis of the type of dosage forms, dosing frequency, and additional directions for use of antihypertensive drugs. Patients were further restricted to those who visited the same medical specialty to examine specialty-specific variations in the MRCI and MPR.The mean MPR was 54.83%, and the sample sizes for the low-, medium-, and high-MPR groups were 9806 (49.38%), 4619 (23.26%), and 5434 (27.36%), respectively. More than 50% of the patients visited the same medical specialty during the 1-year follow-up. The mean MRCI was 3.64; the cardiology specialty had the highest MRCI, and the family medicine specialty had the lowest. Multiple linear regression analyses showed that MRCI was negatively associated with MPR (β = −7.75, P ≤ .01) whether or not the patients visited the same medical specialty. For the patients who visited the same medical specialty, those treated by endocrinology and metabolism specialists had a significantly higher MPR (β = 9.87, P ≤ .01) than that of those treated by family medicine specialists.MRCI and medical specialty were both significantly associated with the MPR of newly diagnosed hypertensive patients.

Effects of a 12-Month Educational Intervention on Clinicians' Attitudes/Practices Regarding the Screening Spiritual History.

Patients' spiritual values, beliefs, and preferences are identified in outpatient medical settings by the taking of a screening spiritual history (SSH). We report the impact of an educational/training program on the attitudes/practices of physicians (MDs) and midlevel practitioners (MLPs). A convenience sample of 1082 MDs or MLPs in outpatient practices was approached to participate in a 12-month educational/training program in this single-group experimental study. Of the 1082 professionals, 48% (427 physicians, 93 MLPs) agreed to complete a questionnaire assessing demographics, practice characteristics, religiosity, and attitudes/practices regarding the SSH. Changes in attitudes/practices over time were examined and baseline predictors identified using mixed-effects regression. Of the 520 participants completing questionnaires at baseline, 436 were assessed at 1 month (83.8%) and 432 were assessed at 12 months (83.1%). The belief that MDs should take a SSH did not significantly change over time (B = -0.022, standard error [SE] 0.028, P = 0.426). However, those who took an SSH often/always increased from 16.7% at baseline to 34.8% at 12-month follow-up (B = 0.328, SE 0.030, P < 0.0001), and perceived patient acceptance/appreciation increased from 72.1% to 80.5% (B = 0.074, SE 0.023, P = 0.001). Predictors of increased SSH taking across time among MDs were older age, female sex, family medicine specialty, prior training, and importance of religion; older age was the only predictor in MLPs. Although attitudes toward taking an SSH were not affected, taking an SSH increased initially and was sustained over time, as did the sense that patients accepted/appreciated this practice. Educational programs of this type may be used to increase SSH taking by outpatient MDs and MLPs.

Scopes of Family Medicine to Combat Emerging Diseases Burdens of Rural People of Bangladesh

Family Medicine is gripping interests of researchers, academicians and policymakers in many countries because of its proven efficiency of mitigating rising globalized diseases through primary health care (PHC). Family Physicians having 5-star quality, namely: competent clinician, manager, PHC team-leader, teacher and community leader, are recognized as the frontrunner of the PHC. However, Family Medicine is still either in infancy or unrecognized and prospect of Family Physicians are challenged by status conflict with clinical specialists in many countries including Bangladesh. This study aims to promote the scopes of Family Medicine specialty for improving social, health and economic prospects at rural Bangladesh. A literature review was conducted during March 2015 on health system structure, and trends of morbidity and mortality of major diseases burdens; especially, in rural Bangladesh along with personal contacts with health professionals. Non-communicable diseases are the rising major cause of morbidity and mortality in Bangladesh along with unsettled communicable diseases. Socio-economic, behavioural, cultural and environmental factors are the key determinants of those emerging diseases. Many of those diseases could be prevented and controlled cost-effectively at community level by motivated and competent Family Physicians. Modern medical practices often are neither personcentered nor community-oriented rather than technologybased that conflicts with the principles of Family Medicine. Integration of Family Medicine specialization could be an evidence-based cost-effective strategy of overcoming the rising health and economic risks of rural people related to the emerging diseases.