Family medicine as your career choice.. why and why not!

 Let me clear conflict of interest first. I am Dr. Pratyush and have done my DNB family medicine from Sir Ganga Ram Hospital, New Delhi. I took family medicine at my DNB CET  rank 1725, where during councelling i had options of other clinical specialities like medicine, peds etc at periphery centres. Since i have thought of doing my own “start up” setup my own clinic near to our village, Family medicine was the best option for me.
Every one of us (postgraduate aspirant) may not have decided their plan post their pg courses. Some decide based on their rank, some are clear about their choice and they wait till they get their dream branch. But most of them finally end up doing postgraduate courses and with time everything settles. Life moves on.
Family medicine is not a new branch, in fact its into existence for past so many years. Family medicine is that speciality which finds its place most of govt health reforms plan. But beyond that there is still need of more political committment.
Family medicine is a broad speciality which is designed for specific purpose and that is primary care. Need for primary health care is huge in country like India with over a billion population. Family medicine deals with all age groups and all body systems, its a concept of generalism. There is huge potential for this specialty in terms of job, affordable and quality health care. Only thing we need is more structures health care with defined role of family physicians.
Training in family medicine covers various specialty like internal medicine –  9 months, obs – 3 months, peds 3 months, surgery 3 months, ICU and emergency medicine – 3 month, ent,ophthal, psychiatry, dermatology postings. It also include posting in primary health care. Duration of these postings is not uniform across all institutes. But over all, major posting is medicine then peds, surgery and obs gynae.
Rest all other rules are similar, you have to submit a thesis for which your guide and co -  guides can be from any speciality belased on your thesis topic. At the end you have to give exam which consists of 4 papers. Paper 4 is mcq based only from community medicine. Rest all subjects are asked in other 3 papers. Theory exam is not that tough as it seems because you are expected only the basics.
In practical exam you get 2 cases of medicine, 2 cases of peds and 1 case of surgery or obs/gynae. There will be a separate medicine viva, peds viva and community medicine viva.
Frequently asked questions.
1. I want to do only medicine posting/surgery posting during my tenure as i am intrested only in surgery/medicine.

No, its not possible.

2. Can i extend my posting in few specialities of my choice?

Look, generally u have to follow the set pattern which your institute have made it for its DNB trainees and is also based on NBE guidelines.

3. Can i do superspeciality/subspeciality courses in neurology, cardiology, gastroenterology?

No, if you are interested, u should only take general medicine not family medicine.

4. Any other courses available after family medicine?

Yes, u can do geriatrics, palliative care and various other skill based courses.

5. Are family residents being treated equally in departments being posted?

Mostly yes, you will be treated at par with other residents of department and will be given opportunities in various academic programs of that department. But it also depends on your sincerity and dedication.

6. Is it similar to community medicine?

No, Both are different and their curriculum is different. Family medicine is a clinical speciality where you are going to practice as family physician.

7. Is it a approved/recognised course?

There should be no confusion regarding it. Its approved by MCI and after completing your training you can update it in your MCI and state medical council registration.

8. Is their any postgraduation MD family medicine courses?

Yes, it has been started. New AIIMS which have been set up have also got Department of community and family medicine.

9. What about research opportunities ?

There are lots of research opportunities in this field. We have many journals like journal of family medicine and primary care, rural and remote health etc. If you are interested in research, family medicine and primary care will never disappoint you.

10. What about family medicine conferences?

There are many conferences which takes place at national and international level. WONCA which stands for world organisation of family doctors conducts various confernces on various themes in association with regional groups. Details you can check it on website .
In India we have Academy of family physicians of India which supports and promotes family medicine. AFPI has got a journal . AFPI has got various state chapter which conducts regular CMEs and orientation programs. AFPI conducts national level family medicine and primary care conference. Next conference is at Kochi from 26 jan 2017. There are various bursaries and awards to support you for your travel in many international conferences.

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Topic for thesis protocol – Search for research

Every resident joining any postgraduate course must have faced it. This is probably the first hurdle you will find after joining any postgraduate course.Mostly in hospital its all on you to find a thesis topic and prepare protocol.
Through this post i wanted to simplify the things and clear common errors and give you some basic ideas how to find a best topic for your thesis.
1. Finding a suitable topic for your thesis protocol
A. Choose a topic based on your interest eg, Diabetes, Hypertension, Infectious Disease, Critical care,depression etc.
B. There should not be any scarcity of cases in your hospital as your thesis is a time bound study.
C. Your thesis methodology should not have very costly investigations which is not standard of care for the disease. As you will find it difficult to get it approved from ethics committee.
D. Your thesis topic should be new and unique. Unique in the sense that there is something  new which have not been done before. In reality its very difficult to find a really unique topic, then you can search for topic which have been done else where, which has got different population characteristics but not in your region.

2 Thesis topics ideas.

You can search on or google scholar or to read various published research papers . You can look for thesis topic through these search engines.

1. Assessment of neuropathy through various scale (eg mnsi) and correlation with glyceamic control
2. Assessment of retinopathy and its correlation
3 Assessment of nephropathy
4. Assessment of microvascular complications and correlation with glyceamic control
5 Assessment of depression among t2dm using various depression scale
6. Assessment of well being among t2dm using who 5 point well being score and correlation with glyceamic control
7. Assessment of sexual health among t2dm and its correlation with duration and glyceamic control
8. Assessment of drug compliance among patients of t2dm
9. Knowledge attitude and practice about dietary modifications in t2dm
10. Correlation of vit d
11.correlation of serum magnesium
12. Correlation of serum zinc, chromium
And prevalence of microvascular complications
13. Correlation of above glyceamic control
14. Study on Metformin and B12 level
15. Study on peripheral macrovascular disease and glyceamic control using Doppler
16. Prevalence of osa among diabetic using scales for OSA and its correlation with glyceamic control
Similar studies can be done using various scale for depression, anxiety, drug compliance and well being.

Infectious disease
1. Drug compliance study, psychiatric scales on tuberculosis.
2. Knowledge attitude and practice study among health care providers and general public about
A. Tuberculosis
B. Hiv
C. Dengue
D. Chikungunya
E. Hepatitis b
3. Drug resistance pattern and radiological pattern in tb
4. Clinico laboratory profile of
A. Scrub typhus
B. Leptospirosis
C. Tiberculosis
D. Dengue
E. Chikungunya
F. H1N1
5.Radiological pattern and its correlation with severity and outcome among pulmonary kochs
6. Study using various psychiatric scales in tubercuslos to look for depression anxiety etc
7. study on Discrimnation and stigma among people living with hiv aids
8. Clinical profile, cd4 count and other lab parameters in hiv
9. Osteoporosis in hiv compared to general population using BMD.
10. Study on prevalence of tb and hiv
11. Drug resistance pattern, treatment outcome, in tb/hiv
12. Study on newer modalities like line probe assay cb naat gen probe and comparison with conventional tests like sputum for AFB and chest xray

Critical care
1. KAP study on palliative care
2. Study on hospital acquired infection, drug resistance pattern among icu patients.
3.Prevalence of Icu psychosis
4. Prevalence of critical care neuropathy and its correlation with severity and duration
5. Prevalence of dyselectrolytemia and its correlation with infection and mortality
6. Study using sofa score, apache score and other scores and its correlation with lab parameters and duration of hospital stay
You need to calculate sample size which is usually based on previous studies. Try to keep a achievable sample size.
Observational studies are easier to do.

Its the most important thing. Keep all the references in Vancouver style. You can use this website

This is most common cause of rejection of your thesis protocol.
You must define everything including various scale and values used, its reference range etc in protocol. Inclusion and exclusion criteria should be clearly defined.

Thesis protocol
Please follow guidelines as per national board examination strictly. Dont change the heading by yourself. Keep it as given in the guideline In the same order  otherwise its going to be rejected.

Common mistakes
1. References not in correct order as cited in protocol and numbered in reference column.
2. Reference dont match with the topic.
3. Citing old references
4. Avoid writing “incidence” in observation studies as its a prevalence study
5. Headings should be according to NBE guidelines and in the same order.

P.S. If your research topic is good it will be easier to get your work published later. So choose it wisely.

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Key to health by Mahatma Gandhi

We celebrate today birth anniversary of Mahatma Gandhi who spread the message of truth,peace, self restraint and non violence; Lal bahadur shastri who epitomized simplicity and honesty.

Mahatma Gandhi wrote a book "KEY TO HEALTH" during his confinement in Aga khan palace in pune during 1942-1944.
Lets read this book today on his birth anniversary and understand the philosophy of health.
He made beautiful remarks on ill effects of alcohol, tobacco, opium and other intoxicants. He also defined health in this book and wrote about several determinants of health like air, water, food, condiments and 'brahmcharya' (self restraint).
He considered human body as a miniature universe within and stresses on understanding of our inner human machinery.
In the 2nd part of this book he dealt with natural therapeutics using earth, water, akash, air and sunlight. Most of these like sitz bath, phototherapy, breathing exercises are still being practiced.
He also made it a point to the readers our limitation which despite so much of progress and research is still not enough to understand our human body and brain.

So lets pray for peace, good health and love for everyone.

PDF file link -

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Recent changes in Tuberculosis guidelines 2016

Based on RNTCP guidelines 2016.

1. 3 new goals – cure, prevent resistance and break chain of transmission.
2. Introduction of daily regime
3. Definition and treatment of mono and polyresistance apart from MDR and XDR Tuberculosis
4. Treatment in CAT 1 – 2(HRZE) + 4 (HRE) : Continue ethambutol in continuation phase too 
5. Treatment in CAT 2 – 2(HRZES) + 1(HRZE) + 5 (HRE)
6. Introduction of Bedaquiline as a new drug. ATP synthase inhibitor specifically targets myc. Tb. Indicated in age more than 18 years. Contraindicatef in pregnancy and those taking hormonal OCP. It may be given in patients with stable arrythmia.
7. Definition of presumptive tuberculosis. Duration > 2 weeks etc
8. New algorithm to diagnose Tuberculosis – pulmonary, extrapulmonary, drug resistant.
9. Introduction of Newer molecular methods like CBNAAT and line probe assay in diagnostic algorithm apart from smear microscopy and chest Xray.
10. Diagnosis of tuberculosis based on X-ray will be called as Clinically diagnosed tuberculosis
11. Sputum should be around 2ml and preferably be mucopurulent.
12. Follow up – New and previously treated Drug sensitive pulmonary tuberculosis – No need to extend Intensive phase, sputum microscopy at end of IP and end of treatment, weight monthly, chest x-ray if required.
13. Follow up – MDR tuberculosis – sputum smear monthly 3,4,5,6,7 months in intensive phase and at 3 months interval in continuation phase 9,12,15..., extend ip phase by maximum 3 months total of 9 months.

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WHO - HIV treatment guidelines - 2016

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RNTCP latest treatment guidelines - 2016

Treatment guidelines can be downloaded from the links given below.
Chapter 1
Chapter 2

Zika Virus - Recent updates 2016

Zika virus is a RNA virus belonging to filovirus family and transmitted by Aedes mosquitoes.
Its maternal-fetal transmission and anecdotal reports of sexual transmission have been reported.
Aedes mosquitoes usually bite during the daytime and breed in standing water so prevention is similar to dengue fever.
It’s a predominant mild or asymptomatic dengue like disease without any hemorrhagic tendencies. Symptoms occur in just 20-25% of patients with low case fatality rates. . It causes acute onset low grade fever with multiple small joint pain, muscle ache, eye pain, prostration and maculopapular rash and usually present 2 to 12 days after mosquito bite.
Recent reports suggests its association with fetal microcephaly and intra cranial calcification which requires antenatal serial Ultrasonography and biochemical evaluation in suspected cases
Treatment is bed rest and supportive care.

Similar to dengue aspirin should be avoided and hematocrit and pulse pressure needs to be monitored.
Diagnostic Algorithm for Zika virus detection
Reference :- PAHO & WHO guidelines

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