USTA, Prof Jinan
Lebanon - Family doctor
What work do you do?
I practice family medicine in various settings: teaching as I have an academic position (Associate Professor) at the Family Medicine Department of the American University of Beirut (AUB) Medical Center; Practicing Physician at the University Health Services of the American University of Beirut, a managed care setup where medical services are provided to patients belonging to the Health Insurance Plan managed by AUB; school physician at the International College; and physician in my private clinic where patients usually do not belong to any insurance plan. This is the most challenging and demanding aspect of my practice but also the most rewarding psychologically; it feels good to have an increasing number of patients keep following up over years and refer others to the practice, just because they trust you and believe in you as a doctor and not because they are bound by the regulations of the insurance plan they belong to.
What other interesting activities that you have been involved in?
I recently became president of the Lebanese Society of Family Medicine, planning to work on some of issues that face the practice of family medicine in Lebanon. I am also active in the area of family violence. My interest in the field goes back to over 15 years when I started observing that there are many cases of family violence in my practice and that I was ignoring that part of their life which turned out to be an essential part of their health problems. I started reading about it and attended meetings and conferences in several places, to get more knowledge and connect with people working on the field and learn from their experiences. Some were very supportive, resourceful and helpful.
I am now working with UN agencies, International and local non-governmental organizations in doing research on violence against children and women child, training health care providers and frontline staff (educators, social workers) on recognizing and addressing survivors. My main goal is to get the health care in Lebanon (and hopefully in Arab world) involved in fighting against violence. An audiovisual toolkit is now being developed in Arabic to help health care providers communicate with and assist survivors of family violence
What are your interests as a GP and also outside work?
As physician, I am interested in maternal child health, doing antenatal follow ups, deliveries and then following up the baby; I also enjoy listening to people which can be teaching too. I learnt from the elderly people how to go through life and survive it, and I learnt from the young how to live life and enjoy it. Besides medicine, I am a member of “science days society” that aims at trivializing science and make it an accessible knowledge for all. I do sports regularly, go movies, and get in touch with nature by hiking.
What is it like to be a family doctor in Lebanon?
The health care system in Lebanon is a bit complex. Most ambulatory clinic consultations are private with fee for service usually paid out pocket by the patient. Certain health plans cover ambulatory clinic visits: Some reimburse the patient with the clinic visit fee at a later date (for example, the national social security fund (NSSF) reimburses employees and their dependents only); others would give those enrollee in their care plan limited number of reimbursed clinic visits per year to be dispensed at the discretion of the enrollee.
On the other hand, there are around 11,000 physicians in Lebanon (Lebanese population is estimated to be 4 million), who are graduates of medical schools from more than 75 countries; making the practice of medicine very diverse; There is limited number of family physicians (around 120 only), abundance of Pediatricians and Obstetricians, and a large number (around 3000) of non specialized general practitioners (practicing physicians without going through specialty training). In addition, most medications can be dispensed without prescription in Lebanon, and there are an abundance of centers providing medical services (labs, radiology..), so an individual can have the tests and medications he thinks he needs or as advised by a relative, pharmacist…without having to consult with a physician.
In this situation, in the absence of an implemented national strategy for primary care, a family physician will feel unprotected in an open market, having to compete with medical professionals and non medical individuals since everyone is practicing primary care; family physicians would avoid going to private practice being costly and insecure, and prefer being in a managed care service to guarantee a stable income. Yet, most managed care plans do not approve recognize some of the “costly” tests ordered by the family physician (like CT or MRI) and they request the approval of a “specialist”. This affects the way family physicians are perceived: a referral doctor, incompetent, and less knowledgeable. The Lebanese Society of Family Medicine and the Family Medicine training institutions are collaborating to secure privileges to the family physicians that are similar to other specialties and support their role in primary care.