Wednesday, November 6, 2013

The Good Old GP

The family doctor is fortunately being resurrected again. Yes, he was almost dead the last few decades when the public's obsession with specialties and specialists drove them to high-end tertiary care centers. What they often missed was good holistic care!

The family doctor's role is the most challenging. He has to answer why the newly born cries after feeds, why the school going child is losing his appetite (or atleast that is what mom thinks), why the lady of the house gets the splitting attacks of migrain, how to measure and control the gentleman's BP especially when there is tension at office, why grandad takes so long to pass urine, and how to manage the vomiting and diarrhea of the cousins who are visiting! In other words, he has to be the proverbial jack and dabble with all aspects of health from birth to death.

Being a scarce commodity, a good family doctor can be difficult to find. His qualifications should include a "proper degree" and easy accessibility. He should not be the "white coat monster" to scare the kids with injections if they don't eat their veggies. He should be more like a family friend whom you can consult for almost anything. Another essential quality is "openness". Considering the varied aspects he is called upon to address, he should not be expected to know everything in detail (what is a specialist there for?), but should be willing to seek help and guidance from peers, books or the net. Here is a simple test: if he looks irritated with your persistent questions, or disapproves of you finding something about an illness from the internet and bringing it up, he is not quite your guy! On the other hand, if he says he is unsure and needs to read up or consult, go for him!

The family doctor should know the unique aspects of your body system and that of your family; your allergies, the painkillers or antibiotics that agree with you, your other medical conditions such as diabetes, hypertension, hypothyroidism, peptic ulcer, proness to fits or panic (we call them co-morbidities) that often get thrown off gear during illnesses, and your nature. Treatment or care should ideally be provided in this total context, an aspect that specialists are prone to overlook.

I find that most of the patients who come to seek treatment at a speciality centre do not have family physicians. When I specifically ask them to find one near their homes, they appear reluctant and often seem to lack faith in their GPs.

GPs therefore need to reinvent their role and win back the trust of their patients. Their steady presence and ready availability should be their USPs. It is he who needs to maintain the balance between over-investigating and aggressive super-specialists and innate quacks, and emerge as the medical anchor of the family.

For specialists, patients keep changing but the diseases remain the same. For family physicians, diseases keep changing while the patients remain the same.

As published in HT City ( Hindustan Times) dated 30 June, 2013.
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