Healthcare’s missing link: a family doctor

Eighty-three-year-old Mrs Pai trudges to her family doctor in the next street for all her major and minor ailments. The doctor assures her about her health and talks her worries over, and if he has the time to spare, enquires about her breakfast or her sisters and extended family whom he knows through her.

The older generation still carries fond memories of ‘doctor uncle’, their family doctor (a general practitioner), who, through constant and continuous touch, became their friend, philosopher and guide! However, the family doctor, a prominent medical service provider of yore is a vanishing phenomenon today.

The healthcare system in any community consists of the primary, secondary and tertiary levels. While the last two deal with hospitals and specialist care, the primary forms the first point of contact and treatment.

Today, mushrooming corporate hospitals, disposable incomes that make them affordable, health awareness generated by media information and simple economics of shelling out a few hundreds more for a specialist’s opinion have made the first level insignificant.

Patients ignoring the family physician next door, and doctors opting less for this sector has created a vicious circle leading to a scarcity of this tribe. Hong Kong still has a host of providers to cater to the primary health sector. In the UK, the National Health Service does the same.

A family doctor is one whom the family consults regularly. A good family doctor goes beyond the present illness and provides comprehensive care to the family. He takes continued responsibility of the family’s treatment and well-being, thus gaining their confidence.

A family doctor is a good point of first contact for the patient. Physical examination and talking to the patient point towards the diagnosis to a large extent while simple medical tools in the clinic like ECG,
BP, blood sugar and oxygen level monitors show vital parameters while nebulisers and oxygen cylinders give symptomatic relief.

Out of 10 patients visiting him, only one or two may require referral to hospitals or specialists. The rest are treated by him, better knowledge of their medical and family history making it easier. In a country where the doctor-patient ratio is 1: 921 (December 2017) and inaccessibility to healthcare claims many lives, these doctors have a large role to play.

For the chronically- and terminally-ill, bed-ridden, elderly, crippled, those requiring post-acute and transitional care and progressively complicated cases needing frequent attention, the role of a family doctor cannot be exaggerated.

House-visits are another priority for these patients which was earlier part of a family doctor’s routine, but have become obsolete today. A few hours set apart by him for need-based periodical house-visits would be of immense help to them.

Frequent interaction with the family and its medical history helps him give preventive care, too, as far as heredity and lifestyle diseases go, through health risk assessment and by alerting members about possible issues and measures to counter them. Thus, a good family doctor could include a range of services in the prevention of acute and chronic diseases using vaccinations, medicines or advise on lifestyle changes.

A family doctor’s role as a coordinator of various medical service providers in the treatment of his patients is immensely helpful. Anet work of medical service providers, like nursing personnel, physiotherapists, clinical psychologists, specialists and good hospitals in the locality would be a relief to patients and their families and would minimise service dispensation time and hassles. This kind of wholesome care can lead to social, psychological and emotional relief apart from the physical.

The UN terms stress as the “health epidemic of the 21st century”. With a dependable medical service network back home, working family members can be stress-free regarding the domestic medical needs of their elderly and children left behind.

Concentrating on one locality saves the doctor time, energy and cost. It is also cost-effective for patients as a clinic spends less on staff, space and equipment. Adopting desirable families, registering them, checking the antecedents of home-visit families and charging a monthly fee would ensure a steady income to family doctors.

A family doctor, however, should accept his limitations and view specialists and other medical practitioners as his colleagues for a holistic treatment of his patients rather than as rivals. He should update himself on the developments in the field of medicine and provide alternatives in his absence.

In view of this, Indian universities incorporating family medicine as a specialty after the basic medical degree is a welcome development in the field.