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Missing: the family doc
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Tomorrow is Doctors' Day. PRIYADARSSHINI SHARMA moans the dying breed of family doctors, who used to be so comforting and friendly.
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A LADY went to her gynaecologist and after consultation, also wanted her eye allergy to be treated. The gynaecologist was able to help her. Later, narrating this to her ophthalmologist, she recalls how he requested her not to come to him ever, for any gynaecological problem. " I won't be able to help you in this madam," expressed the doctor helplessly. That's it. Today, if you have a skin problem you go to a dermatologist, if your ear hurts there is the ENT and if the chest is uneasy there is the cardiologist and for knees, the orthopaedic and so on and so forth. Mind you, for each organ there is the specialised doctor and among all these specialised docs, the most loved, comforting and reassuring man from this highly qualified medical fraternity is missing: The family doc.
The family doctor is sadly missing. "What one really misses is the sense of comfort one felt at his presence. It suddenly meant that there was a solution to the problem, whatever the problem," says Dr. Kalyani Devi recalling that their family doc even played matchmaker and was involved in finding a match for her.
It is a sign of the times. The family doctor is no more and in Kochi this system is practically dead. "Mumbai has a healthy tradition of family docs, just as many other parts of the country still stick on to this old system, but sadly in Kochi there are very few doctors who attend house calls and remain a family doc in the true sense." Says Dr Sujit Vasudevan, one of the few who still is a practicing family doctor.
" The concept of the doctor itself has undergone a sea change. At one time there was only the family doc, but now-a days a proliferation of specialities has taken place, much to the benefit of the patient but sadly at a loss to his mental comfort." Recalling the days of his father, who was one of the city's renowned physician, he says: "When patients came to him, he would know their medical and family backgrounds thoroughly, what allergies they have, if they suffered from any congenital problems etc. and then treat them accordingly. A tuberculosis case those days was referred to a sanatorium at Madanapally or one at Thrissur. Thus the family doc was the base unit. Two people, 20 to 25 years before were part of the family, the family doc and the bank agent. Today both these are missing from the family unit."
Undoubtedly it is the age of specialists, the very word bringing an aura of reverential awe but alas no comfort sense. That is where the family doctor is truly missed.
But change has occurred both ways. While from the doctor's point of view, the profession itself has become more commercial and more investigation based, the patients, especially in Kerala, have very high expectations from their doctors, being very literate themselves. " Today the patient wants to be back on his feet in the next 24 hours. In Kerala, the access to specialists is very easy. There is no intermediary between the patient and the specialist. A chest pain takes them directly to a cardiologist, when the pain may be just due to acidity. Thus a specialist examines cases, which may be treated by the G.P or General Practitioner. This way the specialist loses his cutting edge or is rather used wrongly," explains Dr. Vasudevan.
The biggest advantage with the family doctor is the documentation of all ailments, big or small. He knows the inside out of the patient's health and physique, knows his constitution only too well as to advocate what is right for him. The specialised doctor is not for such broad-spectrum diagnosis. His area is very well defined and his focused view may skip the all-over health factor, at times.
"While Britain's NHS has a very strong system of GPs, America is seeing a revival of the family doctor. Americans are rediscovering the family practitioner whereas here we are doing away with him. A new field gaining popularity in the U.S. is to do a residency in family practice, which is called `specialised generalists.' Kerala has moved towards a hospital-based practice. Nobody takes house calls and most doctors operate from hospitals and not from their chambers. There should be a hierarchy in treatment too. The specialist should be given a free hand to practice his specialty. Says Dr. Vasudevan, who relates how patients come to him with reports of endoscopies and CT scans which are at times the ultimate tests doctors ask a patient to undergo.
"Thus the whole system in such a case is moving in the reverse direction. The specialist should be the last court of appeal but this is not happening here."
Regretting the situation, at a more humane level, Dr. B. Rajendran says, "The patients' attitude towards the doctor has altered drastically. Earlier, we became a part and parcel of the family being invited on all the important occasions, naming ceremony, births, deaths and weddings. We were even consulted on important family decisions, so dropping by at the patient's home at odd hours or any time was motivated by a sense of love. Now there is no such closeness between the doctor and the patient. It is all prescription and fee-related."
Whatever the reasons for the vanishing medical man, the loss is a great one for society at large and there is a longing "on the part of patients for that old doc _ one always available, ever kindly, modest in fees and inspiring in manner', but it is in our hands to bring the good ol' doc back in our small families of today.
Physician, heal thyself
DO DOCS follow the prescriptions, which they so strongly advocate?
Hardly, says Dr. Vasudevan. "I parrot it to all my patients. Exercise, cultivate a hobby, watch less TV, drink 8 to 10 glasses of water, walk, take a break every three months, relax, stop worrying, cut down on oils, have regular hours, but when it comes to our own lives we docs are just too busy to follow this prescription completely. We are most prone and susceptible to all the ailments we treat but that is the way it is."
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