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Where is my family doctor?

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Once upon a time, he knew each one of us and our medical history, and was always available. He will be missed

After 45 years I visited the city where I had spent my childhood, Hyderabad, and went to the residential area where my family had lived for 25 years. We siblings spent here the first 20 to 25 years of our lives, from birth until we settled down in our respective careers.  

I was accompanied by my childhood friend who had grown up with me and was a part of all our activities. We made a list of things to identify, hoping that those buildings and premises still existed, and that the connected people were alive and around. The list comprised our primary school, ration shop, tailoring shop, hair-cutting salon (our elders used to call it ‘crop-cutting shop’), ironing shop, milk shop, groceries and oil shop, electrician’s house, plumber’s shop, flour mill, cobbler’s shop, vegetable shop, chemist’s shop, temple, typewriting institute, newspaper and magazine shop, photo studio, book store, cinemas, Irani café, rental cycle shop, coffee-grinding shop, snack shop, radio repairing shop and the most important, our family doctor’s clinic, which had been at his home.

We found that most of the shops had become defunct since the nature of business activity itself had changed. We were happy to visit our primary school, which was not in very good shape.

I was keen to identify our family doctor’s home-cum-clinic and meet some members of the family. I started to recall the association our family had with the doctor; he was an integral part of us at all times. Every area had a family doctor or general physician, who was the first available ‘Dhanvantri’ for local residents, available anytime to take care of non-serious health issues. These doctors were not required to be highly qualified or connected with government hospitals. Many of them were LMPs, RMPs or MBBS degree holders, but they were pillars of society providing a great service to residents with an immense understanding of health issues, and the habits of every family around their area.

A typical family doctor’s clinic will have a red light-bulb on top of the board (with a small netted cage covering it, so nobody steals the bulb) and the board will be written in two languages mentioning the timings and the qualifications. If the red light was on, it meant the doctor was in; it would be visible from a distance.

The clinic will typically have six to eight chairs with one screen with a green cloth. The other side will have one wooden bed, a weighing machine, and a wooden stool in front of the doctor’s revolving chair. Next to the doctor’s chair will be a stand, on top of which will be kept a big white bowl with water and a small towel hanging, and small soap rest attached to the bowl. One can see a table that will have one small spirit lamp to boil water for the injection syringe and needle.

A wooden almarah is the storage place for all medicines, cotton and bandage items with minimal surgical instruments. Every doctor will have a big bottle of cough syrup and paracetamol liquid, hand-made, for fever and cough. Three big bottles of compounded liquid will be on his table, each one to treat different simple ailments. The doctor will also give a written prescription, which you need to take to the chemist and druggist who will prepare and give you then and there.

A family doctor knows everyone by name, the history of health issues for each family member, their food habits, events in the family, visitors who are staying with them and their native place. These details help him or her to quickly arrive at diagnostic decisions.

Our family doctor always had these questions for every patient: What did you eat yesterday?; Where did you eat yesterday; Was food purchased from outside your home?; Did you pass motion today; Do you have headache?; Did you drink well water or tap water?

The doctor’s instruments are the thermometer, BP apparatus (non-electronic), a tongue pusher in steel and a torchlight. There was no pathology test needed in most cases.

The answers to the questions and his knowledge of the health details of the members of each family were his best tools for diagnosis and treatment management.

Not many family physicians had phones in their clinics.

In 1967, it cost 50 paisa for a checkup and a tablet, 75 paisa for a checkup and a capsule, Rs.1.25 for an injection and 25 paisa for a syrup, which included bottle and dosage sticker. Many poor patients were treated free of cost. (For the benefit of the present generation, let me share the purchasing power of money in 1967: gold cost Rs.185 for 10 gram, tea at restaurant 10 paisa and full meals in a hotel 70 paisa). After the clinic hours family doctors did home visits to check on aged people and charged Re.1 for the visit. Some of them had a compounder with them who will carry a big brown medical kit box.

All these doctors received lot of sample pharmaceutical products every day from companies, apart from visiting medical representatives who give them samples. These samples were distributed free of cost to patients. Some clinics were known as poly clinics, some were nursing homes or maternity homes. Most of the specialist doctors also practised as family physicians since they had loyal family patients from their MBBS days. Once they finished their residency they would proudly start a clinic near their house to serve the people as family physicians. Our family doctor handled everything from a cut in the finger to tropical diseases and serious fever till he/she felt the patient needed to be admitted to a hospital. All family doctors would give medical certificates for leave of absence from school or work.

A family doctor was an undeclared elder family member. For 20 plus years for any health issue he was always there for us, even at odd times and on Sundays. He believed he had a moral responsibility to take care of the family.

Next in line were the maid, dhobi, washerman and barber. Each had a different role apart from their professional work pertaining to social and community services. Our barber, while cutting the hair, would collect all family information and pass on news of whatever was happening around the locality, including information on houses available for rent and instances of death and birth.

Our family dhobi once upon a time worked as a dhobi to one of the Nizam’s wives at the Nizam’s Palace. He will share tonnes of interesting romantic stories and eccentric activities of the Nizam’s wives and family — in return for a nice filter coffee made by my mother. He was reappointed by the municipal corporation after crossing the age of 65 as he claimed he did not remember his year of birth!

Our maid was a mobile news carrier of all the houses, apart from the activities that took place on nearby streets. My mother would know what was happening around on a daily basis while my father got it through the barber. I am sure these people also carried news from our house. They invariably had great integrity and attachment with the families and were very emotional with all of us. In fact, our maid named her daughter after my mother. One maid used to shout if we sang inside the bath. 

The doctor is not in

Finally, we found out that the family doctor was no more and that the clinic had been turned into an electrical appliance shop. His son, a doctor, is working in a corporate hospital.

As technology and medical science grew by leaps and bounds we lost the basics of the art of health management. Everyone needs a family doctor who understands our body, habits, physiology, family health history; not a specific specialist. A family doctor would often have even watched us growing up and understands the dynamics of our growing challenges, both mentally and physically.

I was struggling to find a general physician near my house who could be reached or called in anytime to have a first look at my sick mother who was 80-plus. To my disappointment, I could not find one. My only choice was to rush her to a hospital where a wild card entry was given to the intensive care unit with no questions asked and no answers given.

If there was a family doctor or general physician near my house who could endorse the medical decision to admit her in a hospital or determine that she could be treated at home, that would have been a relief. That would have meant management by a doctor who can see her basic health parameters, one who knows her as a human being, with a certain background of her lifestyle and medical history. The handling of my mother’s treatment would then have been determined not only by some technical testing equipment but by a doctor who knew her health history over the years. I even had to pay the dietician’s fees when she was in the ICU with an intravenous feed as prescribed by the doctor, and I am yet to understand what role a dietician had in giving IV fluid to her.

I finally got the answer to my puzzlement from some family members in the medical profession: nobody now opens a clinic as a general physician, and the concept of family doctor itself is vanishing. However, even in advanced countries like the United States your first stop is a family physician, who directs you to the right specialist unless it is an emergency. I just hope we will have general physicians near our homes who became part of our families.

With a heavy heart, I remember our family doctor who looked after us and ensured our healthy growth.

kashyapved@hotmail.com

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Printable version | Jan 19, 2020 9:55:09 PM | https://www.thehindu.com/opinion/open-page/where-is-my-family-doctor/article22918890.ece

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