Family medicine and Eurologic

Europe exists in a political and economic sense, but the continent is far from being homogeneous. The best coffee still is made in Italy, German cars are the most reliable, the French drink too much of their delicious wines and Belgium produces the best beer. I think the marvellous thing about Europe is that many readers will disagree with these statements. Most people appreciate their local habits and products.

Where family practice is concerned, I think there is no disagreement with the opinion that differences across Europe are enormous, and family medicine in some places has developed into a mature state during the last 50 years, whereas in other countries the discipline still is in its puberty. An example of this development stage is described in this issue by Pavlo Kolesnyk (1). His story illustrates the struggles and endorsement of dedicated colleagues in difficult circumstances in the Ukraine. As the article has an optimistic tone and shows confidence in the future, the authors also encourage their colleagues to continue their efforts. There is supporting evidence for their conviction. Marinko and Starfield showed years ago that investing in family medicine was worthwhile (2,3). It not only reduces costs, but also improves the quality of life and even shows a dose–response relationship. Since then, several supportive studies have been published (4).

At medical school, I was taught that epidemiological associations alone are not enough to accept a causal relationship. We also need an explanation for an empirical phenomenon. Švab presented that explanation for the merits of family medicine in his lecture at the Wonca Conference in Prague (5). He elucidated the core values of family practice: personalized medicine, continuity and equity. It all happens during an encounter of the patient with his doctor, based on mutual respect and trust. Trust and respect do not come automatically, both have to be earned, and a continuous relationship facilitates that. In my personal experience, working as a family physician in a neighbourhood with many immigrants, such a continuous relationship is highly appreciated by the patients. Recently, one of my colleagues left the practice and her patients keep asking where she went and who their family doctor is now. We did send out an explanatory letter, but many of our patients do not know how to read. Most of them never experienced family medicine in their home countries; their responses and expressions of experiencing a loss showed that they appreciated not only the doctor, but also the system, in which they had their own, trusted GP.

Unfortunate, despite the convincing evidence in literature and available explanations about the working mechanism, the urge for strengthening family medicine still does not find politically fertile ground when it comes to real investments and not just words. Unfortunately, that is not only the case in the Ukraine. In the Netherlands, the budget for general practice is allowed to grow a mere 1% next year; whereas specialized medicine is allowed a 2.5% increase (inflation is about 3%). The ‘free market’ is considered more important than a well regulated medical system. In addition, the government is shifting more responsibilities to municipalities while decreasing budgets, for example help for youth and elderly, because ‘efficiency will be better.’ ‘It is an economic crisis, isn't it?’ and ‘Brussels (the word for Europe) is demanding it.’

I think the fact that ‘Europe’ is involved in many decisions regarding the health care systems in the European countries makes a strong case for a European Journal of General Practice. We should keep each other informed, and we should compare systems to look for strengths and weaknesses in order to learn from each other (6). One of the new developments in general practice is the introduction of point-of-care tests. Cals et al., describe a set of criteria that should be fulfilled before introducing these tests in general practice (7). We do have experience with some tests (e.g. CRP and D-dimers), but a myriad of tests is coming to us soon. Criteria for deciding which tests to use and which tests not to use, therefore, are needed. These criteria not only refer to test characteristics, but also to usability and user characteristics.

Again, this issue of the Journal makes a strong case for the further development of general practice and family practice in Europe. There is no need to become identical throughout the continent, but there is a need to learn from each other. We trust that you will enjoy reading this issue and await your contribution in the near future.