HEALTH It's time we gave general practitioners the importance they so richly deserve
W hen Mridula Pai was in Class VI, she remembers being rushed to the family doctor at an unearthly hour. She had been unwell most of the year following a severe ear infection. Her chest hurt, and her parents were teary-eyed with worry.
Two minutes into the clinic, her father was shooed out. The doctor (“Uncle”) walked up to her and asked conspiratorially, “So, in how many subjects did you fail?” “Two,” she muttered. “I'll tell your dad! Stop crying now.” Magically, the chest pain vanished, and as an added treat, she also got a bar of chocolate. “That my dad glowered at me all the way home is another story,” she laughs.
This happened 25 years ago. Just imagine a similar thing happening now. If unlucky, the child would probably be rushed to the ICU, where a battery of tests would be ordered, and a paediatric cardiologist called in. Apart from a sick child, the beleaguered parents would be anxious about the huge bill they would have to foot.
“That's why I say a general practitioner is so very vital in the health-care chain,” says G. Lakshmipathi, who has been an Internist and family doctor to many for more than decades. He has watched his patients grow from children and teenagers to parents and even grandparents. The continuity in association helps.In the past, it was this doctor that families relied on for everything from “broken bones and broken hearts to the delivery of babies,” says Dr. Lakshmipathi.
Doctors who are familiar with the family history easily diagnose hereditary conditions. Says R. Ganesan, consultant, Internal Medicine, Vijaya Hospital, Chennai: “I believe a general physician, especially a family physician, helps interconnect the many problems plaguing a patient. And, because you've seen at least a couple of generations of a family, you are in a better position to pinpoint genetic diseases.”
The doctor, who's been a family physician for 22 years now, says the field's interesting for the practitioner too as it involves analysis using knowledge gained over the years. “You learn to narrow down the options…” he says.
And, in a world of super-specialities, why do we need family physicians? “Because we depend on them; they are our comfort zone,” says Sheetal Mehra, an NRI. “My family physician has treated my grandfather, and now sees my daughter too. He ensures that we don't end up taking unnecessary drugs or go in for needless tests. Most important, since he knows our history, he zeroes in on the problem even when all he has is a bunch of vague symptoms narrated to him over an ISD line! The test reports usually prove him right.”
Says Dr. Lakshmipathi “Medical care is most effective when delivered in the context of family, community and society.”
Then why are family physicians disappearing? Among other reasons, because people believe that a specialist is more able, and therefore, in a better position to help them. And, because, the advancing medical knowledge makes the job of staying ‘up-to-date' in myriad fields really difficult, say doctors.
But, despite all this, what keeps the doctors going is patients' unquestioned trust. “Even when they call from abroad at the dead of night, you must realise that hearing you makes them feel better. Respect that,” says Dr. Ganesan.
As for the sceptics who wonder about long distance diagnosis, he says: “When you hear their voice, the face, the family's medical history, all come back. All you need to do is give them a patient hearing. For, even if your sleep is disturbed, you know that you've helped someone else sleep well.”
SUBHA J RAO