Are small neighbourhood clinics slowly coming back?

A jumble of slippers and sandals outside Dr Subrahmanya Bhat’s clinic is a common sight. From early morning till late at night, he attends to a steady stream of patients.

For 42 years, he has been helming Sri Krishna Clinic in Appareddy Palya, a motley extension in upscale Indiranagar. The one-room establishment is a rare sight in a city dotted with posh hospitals that can give five-star hotels a run for their money. Though small clinics are fast disappearing from the city’s medical map, Bhat has managed to survive and thrive.

“I get a minimum of 50-60 patients per day, and that’s because I have restricted the number of patients since I am getting on in years myself. Till two years ago, I would attend to about 100 patients every day,” says the affable doctor.

It is no wonder that people flock to him; he charges just Rs 50 as consultation fees. It goes up to Rs 100 if he dispenses any medicine.
“The big hospitals ask patients to go for investigations like tests, scans and X-rays for any complaint; their policy is to get them to spend more. I understand that most of my clients come from the lower rungs and keep that in mind while prescribing investigations,” he says.

While affordability is one of the reasons why small private clinics should be encouraged, the medical benefits of allowing them to flourish are many, points out Dr VC Shanmuganandan, Joint Director, Association of Healthcare Providers (India).

“Family doctors provide holistic treatment—they know a patient’s history, environment, what kind of treatment specifically suits them, the fallout of a treatment, and so on. They look at patients as a whole while specialists focus on one point,” he says.

The proliferation of specialists and super specialists, combined with a tendency to look up symptoms on Google, has led to the disappearance of many smaller clinics in Bengaluru.

“It has come a full circle now though. People have realised presumptions are detrimental to their health and the popularity of family doctors is on the rise again. So much so that the government and Indian Medical Association are now encouraging young doctors to specialise in becoming family physicians. They are offering MDs and PG diplomas in family medicine,” he says.

Dr Shanmuganandan is of the opinion that family doctors operating in intimate settings like small clinics should be the starting point for any treatment process.

“An ideal situation would be that every consultant or specialist must involve the family doctor; they shouldn’t see a patient without a reference from a family doctor,” he opines.

Advantages of small clinics
- Affordable, easier to access
- Personal care of doctor

Dr Sugami Ramesh, senior consultant in clinical psychology
“Patients who can afford it prefer corporate hospitals---the setting makes them and the doctors feel secure. Advanced technology, availability of all facilities under one roof, and health insurance have made them popular. Hospitals can unleash advertisement campaigns while clinics depend on word-of-mouth publicity. Some patients feel doctors employed at big hospitals must be good. Small clinics do an excellent job. There is trust between patients and doctors in rural areas. In cities, patients are spoilt for choice. In fact, they ‘shop’ for doctors based on online reviews and star ratings.”

Dr Shanmuganandan
“General physicians need not know about pediatrics, obstetrics, gynaecology and so on. Family doctors know a little bit about everything but they will not be specialised in anything.”