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Family physician

Family physician

Primary health care is the backbone of health and wellness

Health profession has traditionally been touted as ‘noble’ and the health-seekers’ trust, equated healers to a “Surrogate God”. A family physician is perceived to be a friendly health worker in your own locality, free from bureaucratic tantrums or overawing medical jargon, who understands you and speaks in your language, who is accessible and polite, compassionate and competent to attend most of your health problems without any time consuming procedures or expensive investigations/ medicines. Such healer is a primary health physician. This concept entails: better health, better care, lower cost. There is a case to build a strong primary care system, which will allow the nation to deliver on the promise for better care. Studies in US have found that healthcare is more effective and of higher quality ― in states with more primary care physicians. Healthcare costs are 33% lower among adults who have primary care physicians.  Family clinics not only provide treatment model but also attend to Preventive aspects, lifestyle and psychosocial aspects and all round wellness. Such family clinics can be set up by annual contributions from the beneficiary family and the government and need not be a fee for service on  every visit. This is the pattern of healthcare in UK, Norway etc. The patient/family has the option to change family physician in case of persistent mismatch. It is strange in India that private physician who sets up his service entirely on his own cost involving debts, is always given a step-motherly treatment. They are subjected to plethora of draconian laws and bye laws, target of criticism by media and public, as well as made to pay commercial charges and umpteen taxes, whereas they should be treated as equal partners in healthcare and compensated for the same.

Family physicians have become an ‘endangered species’ in India

Don’t be surprised if you come to know that such clinics existed in some form when we were children, in our towns and villages soon after freedom. The then doctor was a ‘friend, philosopher and guide’ available 24 × 7 from womb to tomb. Now specialization of medicine is producing experts who know more and more about individual body parts/ organs/systems but tend to ignore the person. They never feel or treat the patients as fellow human beings, who are their next-door neighbors. Now a person with minor injury/accident/burn/acute pain does not know where to go in emergency! With specialists manning high profile clinics/hospitals in cities, people from far and near throng them with the hope and belief that best service is being provided. However, protocols of such hospitals involve expensive admission fees, un-necessary and elaborate tests and avoidable interventions. Whereas a simple problem would have required a few rupees and a few rupees in a family clinic, it may require a fortune in a corporate set-up.

Primary care physician (PCP)

PCP is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. Emergency physicians see many primary care cases, but are trained and organized to focus on episodic care, acute intervention, stabilization, and discharge or transfer or referral to definitive care, with less of a focus on chronic conditions and limited provision for continuing care. More complex and time-intensive diagnostic procedures are usually obtained by referral to specialists, due to either special training with a technology, or increased experience and patient volume that renders a risky procedure safer for the patient. Experience shows that health systems that adhere to the principles of primary health care produce greater efficiency and better health outcomes in terms of both individual and public health.

Need for specialization in family medicine

Patients, because of their long-term association with family physicians, always prefer to maintain their follow-up with their own neighborhood doctor for the ease of comfort, less travel and more personalized approach. This requires family physicians to keep their knowledge and skills upgraded in the advancing medical field. As their specialization is cross-cutting across boundaries, patient and their caregiver have unlimited expectations from the family physicians.  So the need for specialty of family medicine is obvious. We are supposed to treat a person not their organs. Health care providers are confused- not interested in learning and practice of this non-glamorous field. This field of medicine, which will provide 90% of the total medical care, has to be made remunerative to attract the best.

In the undergraduate medical education we propose that Medical Council of India should update the medical course and curriculum to add Family Medicine along with newer generation of topics like Emergency Medicine, Injury science, wellness and preventive medicine, Psychology, and components of first responder training for pre-hospital care, the science and art of Counseling , Empathy and Ethics.

Right hand doesn’t know what left is doing

Lancet Commission had advised India in 2013 to  invest $23.6 billion annually over the next 20 years to achieve a convergence with global levels on infectious disease, child and maternal mortality rates. The BJP manifesto had also promised universal healthcare and a focus on rural health. Recently National Health Policy was unveiled i e Primary care is to be free for all. The policy also makes a case for more than doubling government spending on healthcare from 1.04 per cent of GDP, to 2.5 per cent. This announcement came just days after the news that the healthcare Budget was to be cut by 20%, reducing it less than 1% of GDP.  The contradiction is obvious.  Can we achieve health for all when right hand does not know what left is doing?

Dr. R.Kumar

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