Table 4 Results of qualitative open-coding analysis in this study

Foundation of family medicine

 The comprehension of the importance of evidence-based practice

“Looking for an evidence-based practice is possible for a family physician because the literature are always change throughout the time. The literature of family medicine also strongly suggested that we should keep up to date with the newest evidences. I think it is good if we build a network among us (the GPs), so that we could discuss any evidences”

 The use of complementary alternative medicine

“I had a patient with cerebral palsy and she lives at home with her mother who already very old. She did not have any access to hospital and then a nearby midwives was asking for my help. So I initiated to do a home visit with my nurse. The patient could not move and having very severe infection of ‘decubitus’ and also on her vagina, the worst wound you may imagine. I then remembered from the weekly clinical update that we may use honey. So I tried. I clear her wounds each day, slowly, and surprisingly it worked out very well. Just a regular honey!”

“My patient had a diabetic ulcer and I referred him to the hospital and the surgeon decided to do ‘amputation’. The patient refused. He came back to me and insisted that he only wanted me to care for him. I was puzzled. Then I remember from the Weekly update, the appraisals about honey and the discussion with the faculty surgeon during that appraisal session. I did an informed consent with the patient. And also that he must obey the regular diabetic treatment that he has. So I started to debridement the wound and carefully use regular honey. Surprisingly, after e period, the wound healed, he could walk normally and now he keeps healthier life”

 The importance of home-visits and understanding a family

“As a GP, we could also do a home-care and home-visits, so that we understand the family context of an elderly. There is new financial system at the primary care centers, I am sure we could manage it to provide extra incentives for health professionals who do home care and home visits”

 The comprehension on family and individual life cycle in regards to individual illnesses

“Thank you for giving me an opportunity to reflect on elderly patient – care with many complex problems. I knew now the cycle of life and cycle of a family so I understand that it is also difficult for her son (who also has a family and adolescence teenagers) to take care of their parents at home. It is a complexity of life that we, as a family physician should understand better”

 Initiated community group learning

“Starting to care for chronic illnesses like hypertension and diabetes mellitus based on the national insurance program, we formed a community health group meeting; which ultimately self-funded and self-regulated. It is amazing to see that the elderly people initiate to have periodic meetings, recreation…”

 Closer steps to patient centred care

“I understand that listening, is very important and we may come to different diagnosis and more correct treatment after deeper listening”

“Now I know that we should ‘well-prepared’ the patient before they referred to a hospital, so sufficient information is highly important for the patient to understand what specialists may do in hospitals and how they could discuss with them”

“As a fresh graduate doctor, twenty years ago, I worked at a remote area. There was an abortion case and I was following a correct procedure and then referred the patient to a hospital. However, I might not able to do an adequate communication with the family (since I did not know the technique until I joined this course) so I was on a ‘trial’ in front of a ‘community court’. No lawyer or advocate stood at my side. The husband was misunderstood and blamed me causing his loss of a child. Fortunately, the community trusted my explanation, and I knew that the husband had a several records of misbehave in that community. However, I should not only thinking and performing correct medical procedures, I must communicate with the patient and their family better”

Women’s health

“There was a teenager who was unmarried and pregnant without a husband. She was so depressed and so I have to conduct a family meeting. Her parents; respectable couple in the neighborhood, could not accept the condition and forced to do an abortion. I explained the healthy condition of their daughter and future grandson and so I have taken initiative to assist the family, day by day, week by week, up to years later to going through every stage of a family crisis. Now they are happy and the daughter could continue her education via distance learning program. Now I know that what I did was a part of being family doctor and I am very happy for that”

Child’s health

No discussion on child health problems

Mental health

“The WHO recommended continuity of care for mentally ill patients and shifted from hospital based into community based care. The recommendation has consequences of strengthening primary care team at primary care settings, empowering the family, educating the family and community, and researches in the area of mental illness. Our community clinic has been trying to implement these recommendations via home visits, psycho-education for the family, the formation of cadre for mental illness, group therapy for the patients and also for the family, all in a program called Health Village Mentally Resilience. We also should work together with all health professionals and hospital, to provide two-way comprehensive care towards patient-centered care. There are so many mental disorders at the community settings”

Neurology problems

“I was on duty in a rural area and a patient came back to our clinic. He suddenly could not talk (a young man), has a very weird movement on his extremities. It was not a stroke, but what was it? His father kept talking to me about bad spirit that his neighbor had sent to his family”

“While his father was talking - I had to extremely divide my attention with thinking to a more logical way. I did careful history taking and the patient apparently has consume the metoclopramide. I remember the possibility of allergic and extrapyramidal effects. Fortunately in the clinic we had the antidote that was ‘trihexyphenidil’. I saved the patient and his family was grateful because I won over the bad spirit. Then I explained to the family what happened and he should avoid any metoclopramide”

Adulthood, elderly and chronic care

 The idea to optimize the home-institution for elderly people which was unfamiliar for the context of this study

“I think it is the time to optimize the home-institution for elderly people. Usually we perceived that an elderly home is for neglected elderly. We should have a new perception now that an elderly home is for any elderly who need it. And elderly home could be the best place for them to have a social relationship, to talk, chat, and play games, because elderly needs others to share stories”

“I had a patient with diabetes mellitus type II, chronic. She was often come to my clinic and I already explain anything related to prevention and treatment of diabetes and its complication. She refused any referral to hospitals and she would only visit me. I know her condition got worse and worse and I motivated her to use insulin or to visit hospital. One day she never come again, I know from her neighbor that she died. I should regularly visit her at her home, I regret I never do that…”

Acute care, surgery and infections

 Emergency in baby delivery

“When I was on duty on a remote area of Indonesia, there was an emergency baby delivery that we should be used a vacuum. The baby were twins. It was just me and one very young midwife and no hospital. We did all the procedures correct, but the vacuum was not in good function. The mother was safe, but the twins were died immediately after born. I should have re check all the emergency equipment regularly especially when no other health care settings is around”

 Emergency in shock syndrome

“Once there was a patient with a somewhat medium late allergy reaction came back to our clinic, one hour after a molar excision. The dentist already went home, it was after the working hours. I was lucky that the nurses were so helpful in assisting me not to panic and I realize that I have to check the adrenalin and all other emergency drugs and procedures regularly; no place for expires. Thanks God we saved that patient”

 HIV problems

“I have a patient, he is a teenager and having the HIV. He came to me in his worst condition with candida all over his body. He seemed like a ‘tree’ than a ‘human’. But I tried to communicate with him as a friend. He used to text me until he trusted me to bring his partner to Puskesmas. The partner was agree to do a counseling prior to an HIV test. I also communicated with them that it is important for their parents to know. For this special patient, holistic and comprehensive care as I learned in this course is certainly needed. I also learned on how to do steps of family intervention in a more effective way”

Sensory organs (eye)

No discussion on sensory organs problems

Sensory organs (ENT)

Sensory organs (skin)