A case for family medicine


The first point of contact for a patient should be a family doctor

Family medicine, family doctor, and general practitioner are some of the terms that have turned unfamiliar in society. It is the era of specialisation.

“However, doctors and society have forgotten that family medicine is a specialty too,” said P.K. Sasidharan, former head, Family Medicine, Governemnt Medical College, Kozhikode.

The role of family physicians in the State’s enviable health parameters could not be set aside, he said. Complementing it was a strong primary health care infrastructure covering most health issues. And it did not take long for Kerala to get the desired results, said Dr. Sasidharan.

Good ante-natal and post-natal care; immunisation; and nutritious food to children for the last 40 years — one would expect that children in such a society to grow into healthy adults. However, the paradox is that the population has increasingly become dependent on medicines.

“This is is bound to happen in a society when there are nearly 40% specialist doctors and fewer family doctors,” said Dr. Sasidharan, who had started the speciality in 2012 for the first time in India. Policies have not changed in accordance with a shift in the epidemiological burden and, as a result, there is a perpetual rise in the diseased population.

Shift in roles

While the number of doctors is more than what is recommended by the World Health Organisation (WHO), their roles have changed. Except a handful, most new graduates get attached to hospitals as junior doctors — an intermediary step before joining a postgraduation course. Almost all of them prefer working in hospitals helping a specialist consultant so that they get enough time to study. Their work is limited, except when managing the casualty ward.

The pressure is high to pursue a postgraduation. “The society looks for a specialist tag,” said N. Madhu, vice president, Qualified Private Medical Practitioners’ Association.

“Doctors too have professional aspirations,” said Junaid Rahman, immediate past president of IMA-Kochi. However, only 25% manage to get a postgraduation degree.

Urban phenonmenon

There were still a large number of patients who were satisfied to see a doctor at the casualty, said Dr. Rahman.

The disappearance of single-doctor clinics was mostly an urban phenonmenon, he said. In spite of this trend, there were still a few MBBS doctors who were having a roaring practice, he added. But, only a few from the new generation take this step. “It is a wrong notion that people do not accept a doctor with just an MBBS tag,” he added.

With incidences of attacks on doctors increasing, new doctors preferred to work within the safety of a hospital, said Dr. Madhu. The cost of maintaining a clinic was high too, he said.

“All these issues can be resolved when a system of family doctor is re-introduced,” said Dr. Sasidharan. And, it had to come as a matter of policy from the government. The first point of contact for any patient should be a family doctor with a referral system to see a specialist, he said. Most countries abroad, except the US, was following the system.

The concept that specialists could treat better was wrong, said Dr. Sasidharan. “They have little idea of the patient’s history. Many a time, there could be wrong diagnosis, over-investigation, and over treatment. A patient in a big hospital is sent ‘doctor shopping’ for each specialty consultation.

The doctor-patient relationship could be improved with a family doctor. It could also help in quicker diagnosis as they knew their medical history, dietary patterns, and other issues.

‘In a society, 80% of the medical professionals should be family doctors — a prescription for better health as they are a friend, philosopher, and guide,” he said. The problem in India, especially Kerala, was that nearly 40% doctors were specialists now.

Family physicians had high value in the system followed by Denmark and England.

Shyama Rajagopal

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Printable version | Dec 14, 2019 5:53:51 PM |

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