ASOURCE Navi

As our society ages, patients' medical needs are becoming more complex and diverse. In this context, "general practitioners" are attracting attention. In Japan, the general practitioner specialist system was launched in 2018, and general practitioners, who treat patients holistically without being limited to specific organs or diseases, play an important role in supporting the health of local communities.
In the second installment, we will summarize the current state and future of general medicine by looking at the skills required of general practitioners, their distribution within Japan, and comparing them with other countries.

General practitioners are required to be able to respond appropriately to patients' vague symptoms, such as "I just don't feel well." To do this, they must first have clinical reasoning skills. It is essential to be able to list a wide range of possible illnesses from limited information, differentiate them, and arrive at a diagnosis.
In addition, communication skills are extremely important for coordinating with not only the patient but also their family and multiple professions. It is necessary to provide satisfactory medical care while respecting the background and values of each patient.
Furthermore, in order to provide community-based medical care, general practitioners must also have the ability to understand the local culture, lifestyles of the residents, and available medical resources. They must also be able to respond flexibly to the different needs of each community.
In addition, educational and research capabilities are also considered important in order to improve the quality of regional medical care. By actively participating not only in medical settings but also in educational institutions and research activities, it is expected that we will contribute to improving the level of medical care throughout the region.

General practitioners are more prevalent in rural areas than in urban areas. For example, in Tokyo, general practitioners account for approximately 7.8% of hospital-based physicians, while in Tokushima Prefecture it is approximately 20.0% and in Kochi Prefecture it is 19.4%, meaning that general practitioners have a greater presence in rural areas.
The background to this is that in rural areas, there is a particular demand for general practitioners who can cover a wide range of fields, as there are only a limited number of doctors in specialized medical fields.In addition, in recent years, there has been an increase in cases where medical students who entered medical school under the "regional quota admission" system work in their hometowns or remote areas after graduation, and a system to support regional medical care is gradually being put in place.

In other countries, general practice has played an important role in the healthcare system, even before it did in Japan. In each country's healthcare system, general practitioners function as the core of community healthcare, and are involved in a wide range of care, from initial patient care to ongoing health management.
In the UK, general practitioners are central to community medical care and act as the first point of contact for patients. In addition to treating a wide range of symptoms and referring patients to specialists as needed, they are also involved in the long-term management of chronic diseases, home medical care for the elderly, cancer diagnosis and referrals, and palliative care. In cooperation with nurses and social workers, there is a system in place to provide comprehensive and continuous care.
Family physicians in the United States act as a single point of contact for patients' health management, providing routine medical care, chronic disease management, and preventive care. They typically specialize in outpatient care, with hospitalists handling inpatient care. In some regions, family physicians are also responsible for inpatient management. They provide efficient, high-quality care through teamwork with nurses and clinical nurses. They also contribute to the appropriate use of medical resources by providing referrals to specialists within the health insurance system.
In Australia, general practitioners act as "family doctors" and provide a wide range of services, including examining patients for colds and injuries, conducting health checks, and referring patients to specialists. In urban areas as well as in remote areas, doctors known as "rural generalists" also provide specialized medical care such as emergency medicine and obstetrics, which are considered part of the general medical field. Rural generalists are trained through the Rural Generalist Program.

In Japan, the "free access system" in which patients can freely choose medical institutions has been in place for a long time. As a result, the systematization of general medical practices specializing in primary care is currently lagging behind other countries.
Given this background, the existence of general practitioners is not yet fully recognized, and they remain a new field within the specialist physician system. However, as discussions on community-based comprehensive care progress, the role of general practitioner specialists is being reevaluated. Going forward, important issues will be the development of a training system for general practitioners, the clarification of their career paths, and raising public awareness.
Additionally, it is necessary to build a sustainable medical care system by referring to examples from overseas and collaborating with Japan's unique regional medical initiatives.

General practitioners are doctors with the "comprehensive ability" to not only treat the illness itself, but also to understand the patient's background and lifestyle. As the population ages, they are also expected to play a key role in home medical care. Their role will likely become even more important in the future as they respond to the increasing demand for aging and community medical care.
With increased institutional support and social understanding, it is expected that the opportunities for general practitioners to work will expand even further.