Saturday, April 19, 2008

Vanishing tribe of general practitioners

-by KParthasarathi Saturday, April 19, 2008
When I was a young boy we had an elderly family physician who was someone more than a family friend. He knew every member of the family, what their regular problems were and their general state of health. A kindly soul he did not seek any publicity except for his name board showing his name and his MBBS qualification. A room in the front portion served as a consulting room and the one behind used for dressing and for making medicines. Although he had prescribed hours for consultation and dispensing, he was always available for emergencies unless he was out on visit to his patients. There will be a crowd of patients sitting on the benches both in his consulting room and outside in the verandah.There was a stool by his side where the patient will sit and relate his complaints. There was no privacy. Everyone can hear unless spoken in whisper. A jovial man he would ask questions to his own mirth and that of the waiting patients. There will be the inevitable physical examination and reading of the temperature. He relied mostly on his diagnostic skill and rarely referred patients for laboratory or radiological tests. He will scribble in a slip the ingredients of the mixture for the patient to give to the compounder in the adjoining room. He used to take a paltry sum that covered the consultation fee and the cost of mixture in a corked bottle with dosages indicated by a paper strip pasted on the bottle. The medicine would last for two days and in most cases there would be no need to visit him again.
Each locality had a couple of general practitioners (GPs) who took care of all the families (both rich and poor), diagnosed and treated all common medical illnesses and did minor surgery. As a family doctor, our physician was loved and respected. He would have visited almost all the houses on some occasion or the other. He had by long experience gained the ability to see the big picture and also zero in on the root cause of the problem. He was a Jack of all trades, could pull a tooth, set fractures, stitch open wounds, and remove the blocking wax from the ear and so on. He will himself refer to hospital where the cases were serious and called for hospitalised treatment. I have seen in some localities even LMPs commanded considerable practice with success. The patients had tremendous faith in the curative powers of their doctors. The GPs too those days were compassionate and treated poor patients free giving them the free samples of medicines they received and took with this purpose in mind from the medical representatives who came to meet them.
The situation today is vastly different. GPs with rich experience are a rarity. Most of the doctors after acquiring MBBS specialise in some area. The scene is fast changing with specialists mushrooming and the prescribing GPs disappearing. The frontiers of medical knowledge and its technology have also extended a lot. The lure of fame and quick riches draw medical graduates to specialise in a narrow area. Where there is money there is crowd. Ophthalmology, Cardiology, Oncology, Cardiovascular surgery, Gastroenterology, ENT, Orthopaedic etc draws the most doctors. The fees of specialists are naturally prohibitive considering the fact only those with specific complaints would visit them. There are no more general physicians or general surgeons in large number as we had a few decades back..
Patients who can afford would prefer to go to a specialist at the earliest opportunity instead of losing time with GP. But the bulk of our problems are minor in nature and a GP should be able to treat them. With easy internet access to patients, they fear the worst scenario and rush to the specialist. Most of the educated have some knowledge of anatomy and the diseases. But the snag is these specialists know in depth only in their limited areas of specialisation. There are the inevitable many referrals to other specialists with innumerable tests and consultations that make treatment way beyond most. Patients generally go to hospitals where they are covered by insurance. All tests are done routinely whether needed or not more as a process of routine elimination. Even a small ailment or a surgery in a hospital run on commercial lines is very prohibitive in cost. The hapless many struggle without going to hospitals or specialists till the problem becomes serious.
Will there ever be the good old general practioners as we had when I was a chit? They may lack the narrow specialisation of the present day specialists but their knowledge in their “parent” fields was beyond question and far superior. They were a boon to the innumerable poor people with the day to day ordinary complaints of a bad cold, fever, tooth pain, a minor fracture and dyspepsia. The commercialisation of medicine and hospitals has caused a great havoc.

1 comment:

  1. i remember a doctor in my early childhood, who had delivered my grandmother.
    you are right when you say that GPs are needed or we have to go to specialists for even minor ailmemts, who sometimes forget that the body is after all one physical entity and not disconnected parts.