Where are the ‘Family Doctors?’

 

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July 1 is celebrated as Doctors’ Day in many countries around the world, when doctors are thanked, felicitated and celebrated for their contribution to humankind. I would like to thank all those wonderful doctors, physicians and surgeons who have treated me over the years and to whom I am deeply indebted.

Unfortunately, I have also had brushes with some who have inspired very little confidence in me and have also caused me grief due to their ineptitude. And no, they were not unqualified or quacks, but highly qualified. In fact I would go as far as to say that they were a tad too qualified – which made them see just that square inch (if not square centimeter) of your body that they had specialised in!

Those were the times when I missed the good old family doctors who were almost part of the family, and who gave you their unbiased and completely honest opinion about your ailment without any ulterior financial motive. It wouldn’t be an exaggeration to say that their compassion helped in speeding up the healing process.

I was heartened to read that the Indian Medical Association (IMA), is trying to revive this great breed, as per this article.

On this World Doctors’ Day, I dedicate this post  from my archives to the Family Doctors, who are fast becoming endangered.

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When a doctor recommends you take a test or have some surgery, ask whether the doctor would suggest that his or her spouse or children go through such a procedure. Contrary to popular belief, doctors can’t cure everyone. So why cause unnecessary pain with surgery I think music and animal therapy can help more than most doctors imagine.

These are not my words, but those of the oldest living physician Dr. Shigeaki Hinohara of Japan, who at 103 is still working as hard as he did when he started practicing medicine! You can read more about this amazing doctor’s advice to people here.

I am sure he is one of those endearing, friendly and fast vanishing neighbourhood physicians, also known as Family Doctors. This species used to take care of everything that ailed us – from corns in the heels to more serious ailments. These family doctors readily made home visits with their typical medical bag, chatting easily with the patient and family over a cup of tea or coffee. All they gave were a few pills and a foul-smelling and evil tasting ‘carminative mixture’ in a squat glass bottle with a slip of paper indicating the dosages pasted on it. It was based on the simple theory that most routine ailments are caused by a faulty digestive tract. What was more, it worked! Very rarely did they give an injection and even more rarely asked us to go for expensive tests or even X-rays.

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When the ailment was serious and warranted specialised diagnosis or care, they referred you to a hospital or a good specialist in the field. Never would they presume to know more than they did and wouldn’t prescribe costly and often unnecessary investigations. Many too, would admonish you to listen to your grandmother and take her home remedies instead of medicines and syrups! They held the basic MBBS degree and no fancy suffixes. Till a quarter century or so earlier, there were RMPs (Registered Medical Practitioners) who did this duty and were a darn sight more efficient and compassionate.

What I liked best about them was their medical bags that contained a plethora of instruments and the way they put you through a ‘physical examination’ that involved touch – actual touch, if you please! He or she would check your pulse; press the stethoscope to your chest and back asking you to ‘take a deep breath and exhale slowly’; check your tonsils by making you say ‘aaaaah’; pull your eye down to check them for telltale redness.  Touch, touch, feel, feel……and a large dose of empathy and compassion — that was the mantra.

Today there are hardly any friendly neighbourhood family doctors, at least in the big metros. In fact, when I looked for pictures of one, I found most of them of rural areas! If at all one finds them in metros today, they are found in seedy neighbourhoods with fictitious medical degrees — often a former compounder of a family doctor of yore — merrily dispensing steroid tablets for the common cold and giving injections to gullible and illiterate slum dwellers, sometimes with serious side effects.

For the rest, there are polyclinics, ‘medical centres’ and hospitals where one has to register oneself for a price to get a fancy folder and a card and become a ‘case’. Once you are inside the consulting room, the doctor looks at your folder and shoots off mandatory questions while scribbling furiously a long list of tests and investigations. And all the time he never looks at you directly or cares to get to know the person behind the list of symptoms. You see, all these are necessary before he or she is able to diagnose what is wrong with you, even if it is just a stuffed nose and a heavy head. I remember the time my maid told me that her doctor had asked her to get an MRI when she went to him complaining of a headache. Just like that!

Ah, the touch! Where is the touch? Oh, your BP is measured with a fancy instrument – by the nurse — not the old sphygmomanometer with its rubber balloon that goes ‘phish phish’, where you can peep to see the mercury rising with every phish! (I also miss the mercury thermometer which one had to violently jerk to bring down the level of mercury and which you held up the light to read the temperature in Fahrenheit.) No need to touch the patient, see?

Holistic healing means being there for the patient, listening, seeing, touching and empathizing with her or his problem, healing both the body and mind. We have almost forgotten the phrase ‘bedside manner’ as applied to doctors, for that was when doctors sat by the bed to speak and offer words of comfort along with their treatment to patients. In hospitals good doctors still do it. They leave behind hope and a sense of well-being even if they just greeted you or touched your forehead. It matters – a lot – really.

But the value of touch is not lost on the world. So we have Alternative Therapies like Touch Therapy and Reiki. Talk of fragmenting holistic healing!

Not just the doctors from my own childhood, but even the doctors during my children’s childhood were very good. They were the no-nonsense types who gently chided you for panicking and reassured you with their readiness to come on house visits when you needed them. When my older son had been a little kid and was delirious with fever, I was panicky because I was alone at home and it was past 11 pm. We had no phone and one of the kindly neighbours had gone to call our family doctor — a smiling, silver-haired RMP, who lived a few houses away. He had not only come immediately, but also stayed with me to help me sponge the child and reassure both of us with his soothing words and mere presence till the fever came down. No advice to get him admitted to some hospital or nursing home!

And then there was this GP in our Delhi neighbourhood, a wonderful doctor who never over-prescribed potent drugs including antibiotics but gave us gyan in the form of simple home remedies and common sense solutions to many routine health problems. I remember him prescribing an ayurvedic medicine for the younger one’s tonsillitis and advising against surgery. Little wonder that his clinic was never crowded unlike the other one in the vicinity which was posher and the doctor not only  advised many investigations but also prescribed costly medicines.  Our gentle GP finally had to shut shop much to our regret. We never found another one like him in that big city. Wherever you are, Dr. Ravi Anand, may your tribe increase!

In the days of specialisation doctors have become so specialised that they can only see the specific organ or part of the organ that have specialized in, just as Arjuna had seen just the eye of the bird. While the latter had to only kill the bird, the doctor has to cure the ailment in the particular organ or part of the organ. Unfortunately, our body is a complex machine with interconnected parts and unless one takes the whole organ or even the adjacent ones into consideration while prescribing medicines or lines of treatment, the results can be disastrous. Doctors dismiss these as ‘side effects,’ which can sometimes be serious enough to be fatal.

The other day when I had gone to visit my octogenarian uncle, he talked fondly about his cardiologist. No, he was not the topmost cardiologist of the country, but someone who ‘looks at me while speaking to me and answering my questions without glancing at the reports – for all of five minutes,’ he said with utter satisfaction.

What an indictment of the species of specialists! They of course deserve a separate post 🙂

Related post: Oh, Doctor!

Images – Top: www.dreamstime.com Bottom: http://www.rediff.com

28 comments

  1. jaishvats · · Reply

    We now live in an era where everyone thinks he is half a doctor and this confidence is reinforced by dear Google…so some of them go expecting tests and not empathy or reassurance… If tests are not recommended then he is an incompetent doctor…poor family docs! They can’t be blamed solely! yes a word from the doc that there is nothing to worry is the best tonic in the entire world…

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  2. Love you for sharing this post. The family doctors are a variety much more loyal than your own family members. I am sharing one of my experiences here. A year after my marriage I suffered from severe abdominal pain for almost six months. The trouble was this pain occured on the third or fourth day of my periods and most often doctors announced it as spasmodial pain which was common for females. I was taken to three private hospitals and one government hospital but none could find out any other reason for the pain. In fact, one MBBS, MD, prescribed anticiotics for stomach infection. When I finally blacked out, my parents took me to our family doctor who was a general physician. One physical examination and he said this was something to do with Gynaecology. He immediately got a blood test and an ultrasound done. The result showed a two and a half kg growth at the mouth of my uterus. Since then, I have lost faith in private hospitals and fancy doctors. If this angel wouldn’t have diagnosed my problem and referred me for an immediate surgery, I would have never had the chance of bearing babies.

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    1. Oh God! That sounds most terrible, but not surprising. Thank God it got sorted out before it was too late. The fact is, those GPs knew about disorders without resorting to fancy diagnostic tools and didn’t refer to specialists because they were more honest and didn’t do it for the ‘cuts’ they got from them. I have several horror stories of my own, but haven’t shared them here. In fact, they were the reasons for this post in the first place. Thanks for sharing your experience.

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  3. Very nice post. I liked it very much. I live in USA. Even here, family doctors are a vanishing breed. Why? Family doctors do not make that much money (after paying for the malpractice insurance). Everyone wants a Marcus Welby, MD. It is an old TV show. (Please google it and read.) Dr. Welby, a fictional doctor, did what all you described about the “family doctors” in the old days.

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    1. This Dr.Welby sounds interesting. I will surely read and try to watch the serial if I can 🙂 What I can’t understand is why doctors can’t be doctors and show some compassion to their patients. There are handful of them still even in big hospitals thankfully. Have you seen Patch Adams? He did all the things our good old family doctor did in a big hospital. And he was a real person, probably still alive — in the US. We made a filmy rehash of that movie in Munnabhai 🙂

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  4. Today most of the doctors are not ethical..they suggest unnecessary tests even to poor people, suggest surgery all the time knowing that it would make no difference.

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    1. But Renu, it makes a difference to their finances 🙂 Who cares about the patient?

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  5. Found In Folsom · · Reply

    I don’t remember having a family doctor as we moved many times. But my dad’s side of the family always had few family doctors as we lived in a small town and village. And oh….so many stories to share. The best I can share is my son’s pediatrician back home. He was such busy doctor who would see patients from morn to night..As we know him, mom would just wait with my son in arms and peep through the door..he would signal to come in whenever the rush was less…no appointment, nothing. And not so many medicines. He sees kids till almost 10 in the night and his house was attached to the hosp. May his tribe grow, Dr. Ranga Rao.

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    1. The sincere ones always treated their profession as a sacred duty to their patients. And they never put their patients through any unnecessary tests and investigations but tried to mitigate the suffering with compassion. Yes, my their tribe increase and benefit mankind.

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  6. When you talked about Dr.Ravi Anand, I remembered our Hosur Doctor.Subramanian. He was against prescribing unnecessary medicines, esp. anti biotics. So when people from surrounding villages visited him, he knew that unless ‘oosi kuththalenna’, they won’t feel they became alright (injection). So, he used to inject distilled water into them and took some Rs.5. He was a very good doctor. What you said for your doctor happened to him, he had to wind shop and go back to his native place, Madurai (Madurai people are lucky now!)

    I remember taking home icecream coloured ‘mixture’ in a flat bottle with hexagonal white strips for dosage. We used to visit him ony once and we were cured! We never heard of all these tests in those days. Now, before going to the US, a couple of months back, I was coughing because of the after effect of cold and my husband asked me to go to a nearby doctor and take medicine for the cough. He said, ‘have one injection now. My man will come and collect blood from your house for the H1N1 test since US has got many cases of this disease.’. I said I am not going to have the injection, he prescribed 6 medicines…one antibiotic for 5 days included. I bought the medicines and took it along with me, but never tood it. I was OK within 2-3 days!

    So many stories are there. Very good and interesting post, Zephyr!

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  7. Zephyr you have exposed this uncomfortable side of medical practice today.It is true that these are days of over-investigations,over-diagnosis and over-medications.
    What to do?Got to live in the times!

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    1. True, Indu. We live in the times of callous doctors and inflated medical bills. But the sight of a hospital or nursing home gives me the shivers for one never knows what one is going to encounter inside one of the wards especially if you are the patient! And today, since we can’t find good GPs, we have to enter the portals of one these 😦

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  8. I liked the bit about carminative mixture – I remember it in a dirty pink colour and usually accompanied with pills of assorted colours to cure any ailment! Could it be that the doctors were compassionate knowing that his patients had to suffer the torture of their medicines?!!

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    1. Hey, good to see your comment, Anand! Ha ha. I love your conjecture about doctors being compassionate for us suffering their medication. By that token however, today’s doctors should be super compassionate, right?

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  9. Another trip down memory lane, Zephyr! 🙂

    Yes, I too, remember with fondness our family doctor who would answer all my anxious questions during our children’s various illnesses. Never would he brush me off or seem too busy.

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    1. The very term Family Doctor is such a reassuring one, isn’t it? How many of them used to simply offer kind words and little medication and yet manage to alleviate the illness! When we had both fallen ill recently with flu, we simply took recourse to home remedies and homeo medicines, taking just paracetamol to control the fever. If we had played into the hands of a hospital, I wonder if I would have been strong enough to blog 🙂

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  10. Having been brought up in a Company town-Neyveli, never really had any experience of a family doctor. But the rest, yes. Someone who first listened to all the symptoms, probed into the nature of the symptoms, touched you, reassured you and only then went into diagnosis and prescriptions. As Beloo said above, the medical profession has ceased to be a ‘caring’ profession and has become totally mercenary.

    I am afraid, though, that we are to blame for it more than they are. Time was when we used to respect at least some professionals merely for BEING professionals in those areas – teaching, medicine etc. – and, thus, even if they were not rich, they had social respect that transcended their financial status. NOW, we respect ONLY financial status and, then, throw up our hands and wail about the ‘mercenary’ medical profession and the lack of quality teachers.

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    1. I can understand the care and concern in a township hospital as the staff would be employees of the organisation which they served. But I disagree about we not respecting medical professionals though I agree hundred percent with your observation of not respecting teachers as they should be because they have the weighty job of shaping the minds and futures of the students. But doctors don’t fall in this category. As I repeatedly say, they have turned cold and commercial because they can afford to — there are so few of them compared to the huge population. According to a study we have less than one doctor for every 3000 people in our country. It is the very poor that suffer the most because specialists fawn over rich patients for obvious reasons.

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  11. You have highlighted an important issue very nicely
    Will there ever be the good old general practitioners as we had when when we were young? These GPs may lack the narrow specialization of the present day specialists but their knowledge in their “parent” fields was beyond question and their diagnostic skills fexcellent. They were a boon to the innumerable poor people with the day to day common complaints of a bad cold, fever, tooth pain, a minor fracture and dyspepsia. The commercialization of medicine,the specialization that doctors go for and the fleecing hospitals have caused a great havoc by making the treatment unaffordable.With the disappearance of GPs,the poor suffer silently and mostly.

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    1. One reason why the GPs of old were so effective was because they saw a wider variety of illnesses and so were experienced in treating them. Also, costly diagnostic equipment were beyond the reach of individual doctors and were mostly available only in big hospitals where they referred the patients when warranted. Today doctors come from affluent families as only they can afford the fees of a medical college and there is no dearth of bank loans for them to set up a private hospital or nursing home and equipping it with costly machines. Once that is done, they have to recover the cost of the machines and so the needless investigations and tests. There is also a clos collaboration between smaller clinics and these centres which makes it a racket of great proportions. Medical insurance is another reason for the cost of healthcare going through the roof.

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  12. O yes, the medical profession has become just that – a profession, and not really a service work as it was/is supposed to be. I have seen a term called “caring professions’ being used to describe doctors, psychologists, nurses etc. But most of the practitioners in the medical community today are not really into the ‘caring’ part, perhaps it is also because of the organisational structure and work culture of the institutions where they are working. The big hospitals are now organised as big corporations, concerned about profits and revenues. Those neighborhood family doctors are really becoming a breed of the past. Do you remember the movie – Munnabhai MBBS? I thought it gave a good reminder (and in a delightful manner) about what has gone missing from the doctors’ work these days.

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    1. You are so right. The caring part is certainly missing. For the most part they all act as if they are super busy and make it look like as if they are doing us a favour just looking at us! As I said, they are in the sellers’ market and so behave in such a callous manner. Of course there are some good doctors even in large hospitals who treat their patients as human beings but their numbers are miniscule. I have seen Munnabhai, which itself is a very filmy adaptation of Patch Adams, the movie in which Robin Willians had essayed the title role. Patch Adams was a real doctor who had done all the things that the movie had shown. I think he is still alive. You should see the movie, I am sure it is available on Youtube. I have seen it several times and am struck by the personality of the doctor every single time!

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      1. Oh, I didn’t know about this Patch Adams movie, will surely check it out sometime. Thanks!

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        1. I am sure you will love it. Since it is a true story and also deals with medical etiquette and compassion, it is a memorable movie.

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  13. Yes, I remember a couple of those family doctors from my childhood. Since we moved around so much, it was impossible to find an old, faithful that lasted us years. But yes, their smile, their gentle talk and their self assured manner made half of our illnesses go away. Alas, this species is very rare. I was very fortunate to find a pediatrician like this in Bangalore. He would pick up his phone no matter what time you called. He always spoke to the kids with a smile. And, he would always hold back the medicines. Now that the kids are older and he has moved to some other place, we don’t get to see him. But, I will always remember him. The other day when my younger son was injured after an accident, we took him to Emergency of a nearby hospital. The doctor was so detached and he actually got irritated at the questions of frightened parents who needed some assuring. He even retorted to my husband, “I am the doctor here. I know what to do!” I felt that he had no clue how to manage the emotions of a whimpering young boy and his scared parents.

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    1. Your hospital experience is the norm these days, Rachna. Only the other day when we visited an elderly neighbour in the hospital his children spoke about how the doctors insisted on speaking in Hindi, a language he wasn’t familiar with or addressing his children, as if he were not competent to understand what they were talking. All designed to demoralise an already suffering patient who needs some reassurance. And the ‘I am the doctor’ speech sounds more like an affirmation for themselves than to the patients! If they knew what they were doing, they might not be so rude, I guess 🙂 We do remember those gentle GPs who put themselves out for their patients years later, don’t we?

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  14. Rajendra Ganatra · · Reply

    Superb note. Entirely agree. Unfortunately doctors have become mercenaries! To remedy the menace, the public at large has to be imparted medical-literacy!

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    1. Great to see you here, Rajendra! Today all vocations have become commercial jobs and so the commitment and compassion are both missing from them. This also includes teaching. And yes, public awareness is necessary, but even being aware, whom do we turn to? I shudder thinking of hospitals and nursing homes that are there to scare and fleece us, the moment we enter the portals.

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