HISTORY OF MEDICINE
Year : 2018 | Volume
: 16 | Issue : 1 | Page : 24--25
Dr. Ian R McWhinney: The father of academic family medicine
Kirubah Vasandhi David
Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
Dr. Kirubah Vasandhi David
Department of Family Medicine, Schell Eye Campus, Christian Medical College and Hospital, Arni Road, Vellore - 632 001, Tamil Nadu
Dr. Ian R McWhinney is well known to most family doctors as the father of academic family medicine (FM). He outlined the philosophical basis, principles, and knowledge of this clinical discipline. He started the very first academic department of FM located at the University of Western Ontario in 1968. He was instrumental in transforming FM worldwide by his visionary writings and research. In collaboration with a group of gifted colleagues, he advanced this discipline from an unknown subject into an academic one with a distinct clinical method and undergraduate and graduate courses. He was renowned for this great empathy, patient-centeredness, and inspired teaching.
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David KV. Dr. Ian R McWhinney: The father of academic family medicine.Curr Med Issues 2018;16:24-25
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David KV. Dr. Ian R McWhinney: The father of academic family medicine. Curr Med Issues [serial online] 2018 [cited 2022 Dec 6 ];16:24-25
Available from: https://www.cmijournal.org/text.asp?2018/16/1/24/231369
Family medicine (FM) is a well-established clinical discipline in most parts of the world. In the United Kingdom and Australia, it is also known as general practice. India is one of a few countries where the government allows the medical trainee to immediately do general practice on completing undergraduate training without any formal training in general practice or FM. It shows the value the medical fraternity in India and the general public place on person-oriented primary care to the common man. FM is a clinical discipline which practices, trains, and conducts research into “knowing the person with the disease” as quoted by Hippocrates. Dr. Ian Renwick McWhinney was pivotal in establishing the foundation of this discipline.
Early Life and Childhood
Ian Renwick McWhinney was born in Burnley, United Kingdom, on October 11, 1926. His father was a busy general practitioner (GP). He grew up watching his father work many long hard hours making house calls on his bicycle. His father talked often of his patients and their social situations. It was just after the First World War when many businesses had collapsed, and poverty and unemployment were prevalent. His father ensured that he and his sister had a good education in a private school.
Early Medical Career
He studied at Cheltenham College from 1940 to 1944. He served with the Royal Army Medical Corps in the Second World War. After the war, he studied at Clare College, Cambridge, and later at St. Bartholomew's Hospital in the University of London. On graduation, he joined his father's practice in Stratford-Upon-Avon where he was a practicing full-time GP for 13 years. He got his MD for a thesis on tuberculosis which was rampant in the UK at that time.
As a young GP, his father would give him a list of patients to see at home. One such visit was for a young man with abdominal pain. In the initial visit, he did not find anything abnormal; however, 2 days later, he was called to visit again as the pain had worsened. The young man had all the textbook signs of acute appendicitis and could not be saved. This experience devastated the young Ian. It led him to record, study, and teach the early signs on any illness which he believed that a GP/family physician should be an expert in. It also made him realize the stark difference of hospital medicine and general practice. Initially, he felt refresher courses or more training in internal medicine would help. He noticed that his fellow GPs would think in terms of symptoms, illnesses, and prognoses rather than categories, diseases, and diagnoses as taught in hospitals. Over the years, he realized the perspective of general practice was different and unique and felt committed to establishing the teaching of this discipline. He took up the challenge of deepening his understanding of FM. He meticulously recorded signs and symptoms of illness he saw in this practice, and this was published as “The Early signs of Illness: Observations in General Practice.”
In 1964, he applied for and received the Nuffield traveling fellowship to spend 6 months traveling through the United States and Canada. It led him to become more certain that general practice had to become an academic subject. He wrote two articles about his reflections which were published in the Lancet in 1966 and 1967. These were seminal articles which outlined the four criteria for an academic discipline: a unique field of action, a defined body of knowledge, an active area of research, and an intellectually rigorous training.
The Call to Academic Family Medicine and Later Academic Life
In 1967, he was called to apply for the post of a chair and professor of FM and start the very first Department of FM in University of Western Ontario in London, Ontario. Dr. Ian was 40 years when he moved to Canada. His ambition to change general practice from a craft to a discipline was starting to get fulfilled. In London, he worked with a core of local GPs who were committed to becoming involved with medical education. There was support from the department of epidemiology and the dean. It dawned on him that most of the other faculty of the medical school did not understand FM. That led him along with his core team to lay down some core basic principles on how FM needs to be taught. The first basic principle was that FM can really be learned only in a family practice. Second, it needs to be taught by family physicians. In the words of the renowned cardiologist and GP, Dr. James Mackenzie, “a teacher of practical matter must be one who has experienced what he teaches.”
This was revolutionary at that time when general practice was still taught in a series of rotations among hospital departments; and thus, the GP was considered as a “pale image of a number of specialists.” This is currently still the situation in our country. When the resident rotates among many specialties, they would start as the most junior in that particular specialty, and would never get the opportunity to become responsible for the holistic care of individual patients. Once Dr. Ian and his team of GP faculty realized that the hospital is not an ideal place to teach FM, they proceeded to start family practices located some distance from the main teaching hospital. A network of teaching practices was started throughout the province of Ontario where resident and medical students were able to learn FM.
In the mid-1970s, he was part of the team that established the Center of Studies in FM where research in FM was taught, and Masters and Doctorate degree in FM is offered. The goal of the Center is to improve FM and primary health care in three contexts: direct care, the community, and the health-care system. Many important research projects on subjects such as access to care, patient-centered clinical method, diabetes care, child health, and integrated and interdisciplinary care were completed. In 1989, his book “Textbook of FM” which has now attained international renown was published. After his tenure as chair and professor of FM in Western was over, he was part of the palliative care team in the community and out of Parkwood Hospital. He continued his research collaborations at the Centre for Studies in FM and to teach in its graduate program. In recognition of his outstanding contributions to the field of FM, he was inducted into the Order of Canada in 2000 and to the Canadian Medical Hall of Fame in 2006.
In his memoir, he mentions three ideas for developing new ideas: one by talking to people, second is by reading widely, and third from clinical medicine.
What can we learn from Dr. Ian McWhinney? The art of early diagnosis and patient-centered care needs to be taught and reflected and is the crux of FM/general practice. It is not addressed in our undergraduate years, and a sense of helplessness comes on when we start practice, pushing the decision to specialize in one organ or patient group. The aspect of specializing in early diagnosis and general-ism which is FM is challenging and though more needed (by 98% of population) has fewer takers. A specialist in one organ system or patient group cannot teach family physicians just as carpenters cannot teach electricians. General practice in India is being done by the great majority of medical graduates without any knowledge of the problems which will be faced by a GP as their teachers have no practical acquaintance with this discipline. Can one imagine the state of our country's health? We need to be inspired by Dr. Ian's role and persist in our efforts to improve the academic discipline of FM.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||McWhinney IR. A Call to Heal: Reflections on a Life in Family Medicine. 1st ed. Manitoba: Benchmark Press; 2012.|