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G P or Specialist?

G P or Specialist?

“It’s more important to know the patient who has the disease, than the disease the patient has.” This was true when Hippocrates said it 2500 years ago — and it remains true today.  General physician (GP) is the need of the hour all over the world. John Hopkins, one of the famous universities in the US has placed great emphasis on a system in which at least 50-60% of the physicians are primary care doctors. This is likely to have better health outcomes, fewer medical mistakes, lower cost, and higher patient satisfaction. Specialty dominated practice also leads to inadequate preventive health services, late detection of diseases, and difficulty managing common chronic conditions such as obesity, diabetes, hypertension, and heart disease. In India it is the paucity of family doctors and lack of primary care, which is responsible for chaos in healthcare delivery. Unfortunately, primary healthcare teaching and practice has always been deeply devalued by medical centers. Primary care is at best the unglamorous and financially unrewarding task of taking good care of patients. Primary docs should be paid more, specialists less. There should be disincentives for overtreatment; incentives for right care. Unfortunately the number of GPs is declining. GP’S are overworked, underpaid, and must shuttle patients in and out of the office in a couple of minutes. Specialists tend to treat the test, not the patient, and earn their living doing tests, interventions, procedures that often are unnecessary.

What is a GP?

In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients. GP manages types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention. The holistic approach of general practice aims to take into consideration the biological, psychological and social factors relevant to the care of each patient’s illness. Their duties are not confined to specific organs of the body, and they have particular skills in treating people with multiple health issues. They are trained to treat patients of any age and sex to levels of complexity. In some healthcare systems GPs work in primary care centers where they play a central role in the healthcare team, while in other models of care GPs can work as single-handed practitioners. GP is usually the first medical practitioner contacted by a patient because of factors such as ease of communication, accessible location, familiarity, and increasingly issues of cost. In some countries, residents are registered as patients of a GP and must contact that doctor for referral to any other. GP can also help you find the right stop smoking services, weight loss service or other self-management programmes that help to prevent or manage a condition. Self-management programmes are not simply about educating you about your condition. They also let you take control of your health by learning new skills to manage your condition on a daily basis.


The “specialty” tag doesn’t always mean better. Hospitals offering advanced care are needed for medical emergencies such as accidents, heart attacks, stroke and cancers, but for minor symptoms like fever, its best to first go to a GP.


Veena Tyagi a middle aged house wife had complaint of breathlessness.“The pulmonologist said it was a lung problem and so she underwent chest X-ray, a pulse oximetry and a sputum test, the cardiologist made her undergo a barrage of tests including an echocardiogram and a treadmill test before announcing fit, the sleep specialist put her under observation for sleep apnea, and the endocrinologist said it could be a hyperactive thyroid, which meant more tests. Finally, it was a GP who glanced at the blood test reports and pointed out the obvious: She had a low hemoglobin level of 7.2 g against a normal of 13.8-17.2 g “The breathlessness was caused by anemia. She is back to her active self following two months of iron supplementation. Thus a GP is a friend, philosopher and guide, if he remains ethical.


Diagnostic tests vs skills


Specialist physicians develop a tunnel vision and are relying so much on diagnostic tests and imaging for diagnosis that some send patients for a gaggle of tests without an overall evaluation where their experience and skill to understand the complex interplay of signs and symptoms come into play. GPs add huge value to diagnosis as they have the perspective and knowledge of a broad spectrum of diagnostic testing and therapeutics. They also understand each patient’s medical history better because of more frequent interaction, which equip them to give personal and continuing care to each. Most patients, especially those with medical insurance today head to super-speciality hospitals at the first sign of fever, when all they need is what their mum would have recommended: paracetamol, water and a couple of days off work to get back on their feet. Why most patients choose to go directly to specialists without referral is because they assume a specialist would know better. “Referral is needed in 10-15% cases only, and close to 90% of daily ailments can be taken care by a general physician,” said a doctor.  GP  understands each patient’s medical history better because of more frequent interaction, which equip them to give personal and continuing care to each, said another doctor.


Keep in mind the following when choosing a GP: Choose someone who is close to your home, accessible at all hours, should be attached to a nursing home so that he can oversee treatment in case you need hospitalization, you are comfortable discussing your health problems as it makes diagnosis easier, and who maintains your health records for future or referral.



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