They say cinema mirrors society, and in the aspect of healthcare, it could not be truer. Since the 1960s, the family doctor has been a central figure in Tamil cinema.
His entry would be preceded by a dramatic zoom-in, invariably of the heroine, who might have just suffered a great shock and subsequently fainted. He would bustle in with his big, black medicine bag, stethoscope around his neck, glasses firmly in place, and tut-tut around the sick bed, advising full bed rest while administering an injection.
Cut to today, where the first reaction is to call an ambulance or rush the person to a hospital. No doctor has time for the patient. They bark out orders to the nurses and instruct the family to buy medicines or give permission for a surgery. The concept of the family physician, who would be on call to go to the patient’s home as needed, has fizzled out over the past couple of decades or so. Even visits to the neighbourhood clinic are passé.
Dr. S.S. Setty, who has been practising medicine for 35 years, explains the phenomenon. “Nowadays, people love specialists: if they have a headache, they want to go to the neurologist and if they have a cough, they want to go to the pneumologist. Of course, if you have a fracture, you have to go to the orthopaedician. The doctors tell them not to come to them directly, but somewhere along the line, the trend has changed. Even now, we are trying to bring back the concept,” he says, adding that this was the topic of conversation at a recent conference by the Indian Medical Association. To this end, Dr. Setty founded Doctor at Your Place in April 2012, a service that offers personalised care in the patient’s house.
“Sometimes, it is not just about physical health. In a home setting, we can gauge what other problems they might be facing. Once, I was called to treat a lady with filariasis. Both her legs were swollen and she never moved out of her room. I suggested to her son that he buy her a wheelchair, which he did that very evening. The next day he called to tell me that both of them are very happy and that he was taking her shopping,” he recounts. Apart from the usual geriatric and palliative care, it is now possible to set up ICU and even CCU conditions in the home. However, with more specialists and less number of general physicians, getting doctors to make house calls is also an uphill task.
Dr. Rathnam, a general physician, says, “They (some doctors) have a chip on their shoulder — since patients flock to them while they sit in a cabin, they consider it too beneath them to go to the patient. Medical students should know that it is the general physicians who are in demand now, and choose their post graduation accordingly.”
Even though family doctors have all but disappeared from the scene, a growing number of clinics and dedicated services offer consultations and check-ups at home without going through the hassle of sitting for hours on end in a hospital waiting room. The charges vary and are slightly higher than if one goes to the hospital.
Apollo Hospitals have had a home healthcare division since 1997, but find that the time is right for expanding and streamlining their operations.
Sources from the hospital say that patient details and history will be digitally recorded, and the safety of their staff will also be taken care of as they visit different homes.
The one thing that will be missing in the kind of house calls that doctors make today is the continued interaction between them and the patient. Dr. Setty says, “I may attend to a patient and then not be free the next time; another doctor will take the call. The relationship and confidentiality a doctor would inspire in their patient is no longer possible.”
