Vanishing breed of family physicians

TODAY IS NATIONAL DOCTORS' DAY

Forty years ago, in Mysuru, when my 58-year-old father sustained a ‘silent heart attack’, our family doctor had rushed to our home and gave my father 2-3 intravenous injections, sat with him for about an hour till my father said “I am ok”. In retrospect, I feel his survival was a real miracle as in the 1970s, the available thrombolytic agents (clot dissolving medication) were very few and new in India.

Yes, the family doctor was really somebody who could attend to all our minor and major ailments, who vaccinated us once a year against cholera during our high school days, who alw­ays correctly diagnosed a typh­oid fever based on the step-ladder type of fever history alone!

With the ‘star hospital’ and ‘the Wi-Fi culture’, patients (or the health insurance company) now a days, have been ending up paying more for the luxury of the hospital infrastructure than for the benefits of the interaction and advice of the health-care specialists.

To give an extraordinary example, when Dr H Sudarshan  gave up lucrative post-graduate options  to serve the Soliga tribals of the B R Hills from the mid-1970s, initially he was nowhere allowed near their ‘podus’ (huts), for the tribals feared him, treated him as a ‘stranger’ and an ‘intruder’ trying to invade their tribal life-sanctity.

When Dr Sudarshan, then in his mid-20s, treated a snake-bite victim by sucking-away and spitting the poisonous blood from the lower limb of the victim, risking his own (the doctor’s) life, the tribals saluted and accepted him as a ‘saviour’.

This can be a very true-life revelation of what a family doctor should be even in the urban-context: a friend in need, a confidant, a counsellor and a healer. Says Dr Sudarshan, winner of The Right Livelihood and Magsaysay awards, who is now also an advisor to the Karnataka government on various governmental-health related projects: “the government should seriously think of reviving the family physician culture both in the urban areas and at the PHC (primary health centre) level.”

He added: “The PHC-serving MBBS graduates, after 3-5 years of their service, can be sponsored for DNB-family physician course of two years. Ideally, a family physician should be the link between the patient and the super-specialists. In UK, in the National Health System, nearly 60-65% of the patients’ illnesses are handled by the family practice doctors. Only when a family doctor cannot treat a patient, will he/she be referred to the specialist. Such a referral system should be put in place and strengthened in India too.” 

Till the 1990s and earlier, a family doctor was easily accessible in terms of proximity and the willingness to help, he used to treat the patients at an affordable cost. A family doctor always tried to understand the ‘psyche’ of the patient and also tried to understand the pattern of the patients’ illness and its consequences. A family physician was somebody who knew which drugs his patient was allergic to, and which month or week a vaccination is needed for a particular child in a house.

Reassuring figure

Says Dr Shirdi Prasad Tekur, a renowned family physician in Bengaluru for over three deca­des: “I usually try to understand all aspects of the lives of my patients across their socio-economic (including nutrition, hobbies, exercise schedule, habits etc), religious and educational backgrounds, lifestyles, their beliefs and their relationships within and outside the family.

A family doctor always had a holistic view and approach while treating a patient and used to be a comforting, soulfully reassuring figure. Whereas now-a-days, when patients directly go to a super-specialist, they are taken aback most of the times by the specialists’ penchant for over-prescribing and concentrating on treating the patient based only on the laboratory data and CT or MRI imaging reports.

The tradition of family doctors will thrive again, if more and more MBBS graduates take up the specialisation in family practice, since family physicians are a vital link in the health care chain. The government can provide medicines, vaccines, referral and documentation support to the family physicians in covering national health programmes by engaging them as reliable nodal points in extending the primary health care to the communities they work in.

Would we ever see the new bunch of family physicians armed with a stethoscope, a BP apparatus and more than an ounce of humanity and a grass-root knowledge about patients’ illness patterns?

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