RESPECT from specialists

I read your interesting findings regarding respect for FPs/GPs by their specialist colleaques.I was amazed because I was of the opinion that these problems existed only in developing countries. Many other complex issues make the issue of respect from specialists even more glaring in developing countries.

In Nigeria, for example, the specialty of General Practice was officially recognized in 1980. There are still many doctors who have not undergone any GP residency training who are still referred to as GPs. There are now a few GPs who have done the GP residency training, and though technically GPs, this small group are now referred to as Family Physicians. There are 2 associations, i.e Association of General Practitioners of Nigeria and the Society of Family Physicians of Nigeria. With this kind of complexity in the specialty, there is no common force to tackle the problem of respect from specialist colleaques.

Furthermore, with the poor primary as well as secondary health structures in this country,coupled with inadequate human resources, more GPs/FPs are engaged in hospital work and fuctioning as "mini-surgeons, mini-obstetricians,mini- gynaecologists, mini-orthopedic surgeons, mini-ophthalmologists, etc. There have been instances where patients' lives were saved through emergency surgery by an experienced "GP surgeon" only for the patient to be told by a specialist surgeon that the operation was done by a GP and "thank God you came out alive" or "he is only a mere GP". I suspect that there is more "bad mouthing" from specialists in Nigeria than in Canada or the USA.

There are also fewer opportunities for academic GP/FP, because there is only one medical school in Nigeria that has General Practice as an academic department. Nigeria has only produced one full Professor of General Practice so far. Even then, this sole GP department has had to, on several occasions, fight hard to continue to exist among other specialist departments. On at least one occasion, a senior medical school official advocated for scrapping the entire General Practice Department, as well as the teaching in general practice.

However, the solutions in your article would go a long way to improve the understanding of the specialty of GP/FM by other specialists, improve the relationship between GPs/FPs and their specialist colleagues and thus increase bilateral respect.

Emmanuel Monjok MD MPH

Formerly, GP with obstetric interest (Nigeria); currently, Research Assistant Professor of Public Health (USA)