Shortly after Poorvaja Prakash moved to Mumbai for work, she had a persistent throat infection, which led to high fever. On visiting a reputed hospital, “The first thing the doctor asked was if I’d like to get admitted,” she says.

After several tests, including one for swine flu, and five days of hospitalisation, “I had a huge bill, and little idea of what was wrong.”

Concept of a GP

Many like Poorvaja run from pillar to post for even simple ailments today, and end up with a pile of test reports and long medical bills.

A chief reason for this, according to Dr Subashini Venkatesh, a Chennai-based General Practitioner, is that the good old family doctor is no longer in the picture; “as science grew, specialities grew,” she says. “Super-specialists grow vertically and are highly focused in their area. But GPs grow laterally to provide complete care. We are jack of all trades.”

Concurring with her, Dr Santanu Chattopadhyay, CEO of NationWide The Family Doctors, says People run to specialists for every small issue. Someone with knee pain, for instance, would prefer an orthopaedic consultation.

“The specialist will look at the patient in parts, but a GP will see the body as a whole,” he explains.

The primary healthcare services of a GP, or family doctor, helps mitigate not just anxiety but also undue costs. “Our treatment is by elimination, not by diagnostics. We rule out one by one. Seventy per cent of the time, just listening to your patient gives you the diagnosis, so you know you are not investigating inappropriately,” says Subashini.

As general practice is not symptom- or disease-specific, it results in wholesome and quality care. A well-trained GP is adept at counselling, addressing the psychological aspects of a disease, elderly care (geriatrics), end-of-life care and pain management among others, apart from small surgeries, paediatrics and dermatology.

Subashini points to the UK, where GP care starts from a baby’s neo-natal checks and vaccinations, and continues well into adulthood and lifetime. “The doctor knows everything about the family — background, history of illness, socio-economic status and so on, which makes it easy to treat the patient,” she says. In the process, a deep bond develops inevitably.

India vs rest

The family doctor is often the first point of contact for patients in many countries. Cuba’s ‘Family Doctor-and-Nurse’ system puts a doctor-nurse duo in charge of around 150 families (700-800 people). This ensures continued primary care at the individual, family and community levels.

India, like several African nations, suffers from the ‘YOYO’ or ‘You are On Your Own’ system, says Dr Jacob John, retired professor from Christian Medical College, Vellore. Research suggests 70-80 per cent of medical expenditure in India is borne “out-of-pocket” by citizens and most of this is spent on out-patient treatment, mainly medicines.

With little focus on primary healthcare, to which family doctors are integral patients are made responsible for their own health. This sees urban patients going “doctor shopping” and rural patients flocking to super-speciality hospitals in the cities. Both groups end up with inadequate healthcare and exorbitant costs, says Subashini.

An ideal model is the UK’s National Health Service, which mandates a visit to the GP, who has the patient’s medical history. After eliminating possible causes, if needed the GP refers the patient to a specialist with their complete medical history.

As John says, “In a good referral system everything will be smooth. But if a priority patient is in the line with everyone else, it is not working.”

Other causes

Increasingly, sheer ignorance of the value of general practice, coupled with rising privatisation of healthcare, lack of training, poor employment, and inadequate primary healthcare infrastructure have made family medicine an endangered practice.

(This is the first of the two-part series on family doctors or general practitioners.)

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