by S. Chandra Shekar
Anyone living in a rural village, town, or big city requires the assistance of a general medical practitioner from time to time. In earlier times we had Family Doctors and General Physicians located at various places serving the local population and taking care of their healthcare. But where are the Family Doctors today?
Districts have General Hospitals and villages have primary health centers. What is the quality of care and nursing facilities and are they available all the time? Do experienced nursing staff attend to emergencies and simple medical treatments? Today’s doctors don’t accept postings to PHC-s. I remember a time when a Doctor visited the centers, was available for consultation, examination, and diagnosis work. He gave instructions to the nursing staff who continuously took care of the patients. Serious cases requiring surgery and important treatment were referred to the nearest hospital in a town or district headquarters. He referred the patients to specialists in the hospital who attended to them.
We had two types of Doctors. The government doctor was always on the move visiting health centers in villages in his circuit. He was the medical equivalent of a Circuit Judge. The other type of Doctor was full time attached to a hospital in a town or city. He had the opportunity to specialize in specific areas of general medicine or surgery.
When hospitals were located in towns and cities, many patients found it difficult to go there. Some patients were economically weak or they had no means of manpower support or transport to visit hospitals personally. This is where the family doctors or GP-s as they were known played a key role. He ran his enterprise on his own, he was the entrepreneur in his medical field. He set up his working area of two rooms. One was the waiting area for the patients and their accompanying people with chairs and reading material. The second was the Examination room where the doctor did his professional work.
On request, he visited the patient at his home, examined him or her, and advised the family members on the course of action to be taken. If home treatment was possible, he trained and taught the family members to do the same. If hospitalization was required he organized it at the nearest hospital within the budget of the patient. But where is the Family Doctor now? Nowhere, is the answer.
Until the 1990s any city area had at least 5 GP-s. Families could go for consultations regularly. In the doctor’s clinic, we had a waiting room and everyone knew everyone. It was a meeting place for young mothers with children and other people both old and young. The Doctor examined a patient systematically and thoroughly. He was a good listener and observer. He knew each patient’s background and health history. His diagnosis was by and large accurate. If required he prescribed a few tests to confirm his diagnosis. Treatment started immediately and he monitored closely the progress. In special cases, he made home visits to examine the recovering patient. He was a friend, philosopher, and guide. The very act of his concerned involvement helped the patient psychologically to recover.
In each suburb, we had small and compact Nursing Homes and hospitals. There were duty doctors round the clock to attend to emergencies and to critical patients. Reasonably well-equipped ICU-s and surgeries were available. Every Nursing Home had to visit and Consulting specialist Doctors who attended to important cases. All these practices were cost-effective and efficient.
Today the GP-s and Nursing Homes have disappeared and big and gigantic Super Speciality Hospitals have taken their place. The cost of examination, treatment, admission, and consultation is so prohibitive. The common citizen is unable to afford these expenses. Only employees of large companies and organizations with medical schemes such as medical cost reimbursement or Insurance facilities can afford to get treated in these hospitals. The concept of Corporate Hospitals which are profit-oriented and provide high-class facilities such as ultra-modern rooms, fittings, and conveniences have segregated the rich and common folk. The Government has tried many citizen-friendly medical insurance schemes. But the paperwork and procedures dissuade common people from using this. The devil is in the detail… in the fine print.
What can be done to right the wrong?
Overspecialization must be discouraged. In the medical community, we can have around 30% of Specialist Doctors and around 70% of General Practitioners. Can the Indian Council of Medical Research or Health Ministry do anything about this?
Incentives can be offered to GP-s to set up practices in rural towns and city suburbs. Why should every Doctor join a hospital? If specialization is the motive for joining Hospitals, can GP-s be given opportunities for training themselves in their chosen field without closing down their family doctor service? In Britain and Australia, the private medical practitioner has a thriving practice and he is supported and encouraged by the Medical Councils. All doctors need not join hospitals to specialize. A family doctor can also specialize without sacrificing his general practice, independence, and yeoman service to society. Unfortunately, the youth of today do not want to go and live in villages or towns because of the lack of good education prospects for their children, the lack of quality housing and entertainment, and the lack of earning capacity for themselves. After all, they have spent a lot just to get their basic degree in medicine. At the end of that basic degree, they still do not get enough clinical experience to strike out on their own.
Let us all try to bring back the GP and the family doctor service.
About the Author:
Chandrashekar Sundara Rajan is a retired engineer with nearly 50+ years of experience in engineering projects all over India. He is well-traveled and has worked in various countries around the world. He is an avid Writer of both Short Stories and Articles of public interest.