Friday, October 23, 2009

Disappearing family doctor

Scene one

Patient A goes to his family physician and says,’ doc, I have this head ache again since this morning’ ‘When was the last time you had it?’ Doc asks. ‘Six months ago, and you gave me some pills to take for two weeks and I became Ok and now I have it again’. Doc refers to the records , quickly checks his [patients] blood pressure and temperature and gives him a prescription and tells him to see him if not better in the next two or three days. Patient thanks the doc and leaves. The whole process takes less than 15 minutes.

Scene two

Patient B finds it hard to go to a family physician or doesn’t have one to go to. But there are hospitals he can go to. He goes to one such. He struggles to find parking place and after that ordeal over he reaches the reception area and stands in the queue. When his turn comes the pretty woman asks him in a monotone about his problem. He begins describing his head ache. She cuts him short and tells him, ‘neurology’ [hospital protocol: all head ache cases are first seen by neurologist] and names a fee which is collected and a file with a doctor’s name on it is given to him. Patient follows the directional arrows leading to the neurology department and ultimately, after several false turns finds it. Another reception area and another receptionist, grim faced one this time takes the folder, looks at it and tells him to wait for the doctor to come as he is busy doing the ward rounds. When his turn comes to see the doctor it is two hours and his head ache is now crescendo. The doctor asks him how long he has had it. He says one day. Any earlier episodes? The doctor asks. Yes he replies. A 15 minutes examination later he is asked to do some tests which includes X-ray of his face [sinuses] and a MRI scan of his brain. [Hospital protocol: for all head ache patients these two investigations are to be done]. The patient trudges to the imaging section and waits in the queue. For his pictures to be done it takes another two hours. He is asked to come next day to collect the reports and see the neurologist. It is past 3 pm and the hungry patient with continuing head ache heads home. Seeing his condition, wife gives him a tablet of saridon and then his belated lunch. By evening after a much needed nap he is head ache free!

Next day he goes and meets up with the neurologist with the reports and tells him that his head ache has now gone. The neurologist prescribes a drug any way and asks him to take it for next two weeks.

The drug given to patient A and B was the same.

Patient A spent 150 Rs and patient B spent 8000 and wasted two days of his time!

The latter scene is likely to be the norm if the present tendency of directly seeking help from the hospitals continues as it is likely to be. The reason why this is happening is the gradual disappearance of family doctors.

I recently attended a CME [continuing medical education] for family physicians. Normally my preferred seat is in the front two rows where the speaker is more audible and visible and it is easy to interact if the need were to arise. But occasionally I prefer the last row. This is when for one reason or the other I find the speaker difficult to suffer and a snooze is preferable to the talk. On one such occasion occupying such a vantage seat, I had a view of all those rows of seated doctors in front. There must be about 80 of them. All the heads were either bald or covered with thinning grey. No black at all! Most were on the wrong side of fifty.

If no young doctor wants to be a family doctor what will the patient do but become patient number two?

Why the young have turned away from family medical practice?

Another post, another time.


Leslie said...

I wholeheartedly agree with you.

You will be happy to note that my family doctor (who is a tremendous aid and support to me in my frustrating ill health) is 40-something. There are still a few new family docs out there.


My thoughts said...

There are lots of persons like you who feel the need to have a doctor to whom they can go to and take treatment, councel and advice.
The society is going to pay a very heavy price if it allows this institution of family practice to die out

G.D. said...

Solo practicing units,poor self esteem due to low incomes, undue hesitation to take risks with the treatment,craze among patients to seek "Specialist Opinion" for simpler ailments etc have made life difficult for Family Physicians.Hence the fine art is slowly but surely dying out.Society will pay a huge price for this folly,with the advent of American style Insurance based medicine in India which is also detrimental to OPD practice.

kingram said...

I think the problem of 'Disappearing Family Doctor' is found in countries where there is no 'Comprehensive Health Care System'. It is the health care system or lack of it encourages people to seek 'Specialist Care' as a first point of contact. I am sure 'my thoughts' is worrying about the state of the family care that is present in India especially in Bangalore. There is no general consenses among medical fraternity about the ethical conducts of specialists. A specialist should never see a patient directly without being referred by a family physician or a primary care doctor. In countries like U.K,Canada and Scandinavian countries, all patients should see a family doctor or a primary care doctor first and then he referrs the patient to a specialist.
During a short period of time, I worked as a family physician in India some years ago, I used to refer patients who needed specialist care. But the specialist after having seen the patients and giving his openion, never referred them back to me for continued care. Not only I lost the patient but also specialists had expanded his practice into family care as well.