Sunday, September 23, 2001		Keeping fit

I grew up in the town of Amritsar, where I had my schooling as well as early college education. Before I had any inkling that I was going to be a doctor myself, my picture of a doctor was what I saw as a child. The doctors practising in the town were all well-known names, dignified and poised, gentle and kind to the patients. They inspired a lot of confidence. There was one such doctor in the area in which I grew. He had come back from Myanmar and was working in a local charitable hospital. The man had amazing skills in delivering medical care and I am referring to the late 40s and early 50s when there were not many drugs and other therapeutics available. He could take care of patients with fever, diarrhoea and other illnesses, take care of children, obstetrics and gynaecological problems, he could perform minor surgeries and I even saw him doing dental extractions and applying plasters for minor injuries. He could attend to minor eye and ENT problems. In fact, in my limited perception I thought he could do anything.

These practitioners of medicine were indeed excellent family doctors. They looked after families over generations in a given area and cared for them in the real sense. Even more important than the clinical skill they employed was that they looked after the families at all levels and provided general guidance in day-to-day health matters, covering everyone from a new born to the grandfather of the house.

But the scene has changed and today the same town of Amritsar (or any town indeed) is full of all kinds of specialists with postgraduate and super-speciality qualifications. Both the doctor and the patient and the public at large often apply shortcuts to get quick diagnosis and cure. Technology has "dulled" the gentle art of medicine and that in turn has decreased the doctors’ direct interest in the patient as an individual. Their specialisation and super-specialisation has only aggravated the situation. The affluent class particularly, wants to reach the super-specialist quickly and directly and in this process, often uses shortcuts. All these factors, coupled with the mobility of the population, has decreased personal doctor-patient interaction, leading to the decline of the institution of family doctor.

I have no doubt whatsoever that we need family doctors as much as before. Only they can provide one-to-one patient care and make use of their intimate personal and family knowledge of the patient. It is the duty of the primary physician or the family doctor to guide the patient through illness even when he has to refer to a specialist or an institution. To carry out this difficult task, the family physician not only needs skills of his own but familiarity with the techniques, skills and placement of various specialists in various branches of medicine.

Paradoxically, with the advent of modern technology and specialisation the need for a family doctor has become more acute. The patient and the family need protection against the onslaught of impersonal, technical and high-cost medical care, not to speak of the unscrupulous practices that are rampant are today.

We, in our country, still do not have a formal course in family medical practice. Many years ago, Dr Vijay Kumar, a paediatrician who is deeply interested in community medicine, did moot the idea of starting a course in family practice at the PGI, Chandigarh. But somehow it did not take off.

In the USA, in spite of the advanced technology, the practice of family doctor is an important branch of medicine.

The family doctor can also play a pivotal role in the lives of local families at all levels. His role, in fact, starts with the very conception of a baby and entails giving advice to the expectant mother, protecting her from various problems later advising about the feeding, immunisation and other needs of a new-born.

Both the community and the medical profession need to think over the need for and philosophy behind this institution.

At the education level, the Medical Council of India and PGI need to seriously consider starting a postgraduate training course in family practice.