City dwellers, particularly those who lived earlier in smaller towns, are familiar with an institution called ‘family doctor’. They are aware of the role played by the family doctor. Some of us may be having nostalgic memories of a family doctor who was a friend, philosopher and guide too!
The family doctor of the good old days was essentially a general medical practitioner. What was so special about service provided by a family doctor? Why do many of my generation still remember the family doctor?
The family doc had just a basic qualification to practice medicine and that was good enough. Very rarely was a family doctor a highly qualified person. He was a sort of ‘jack of all and master of none’ type physician.
The family doc always knew his patients’ family background and his memory was good enough to store the medical history of scores of his patients and their families. Over a period of time, using his experience, he could provide dependable service as a medical practitioner.
Though the family doc was not a specialist himself, he did not feel it necessary to consult someone else. Thus, he rarely referred his patients to a specialist. Further, he did not expect his patients to undergo this or that pathological test.
If the institution of family doctor fulfilled the need of society and served it well some forty–fifty years back, the question is, why has it been weakened now? Another question: is it becoming more and irrelevant today?
What is threatening institution of family doctor? Is it that since the medical profession has become more commercialized, the family doctor, who provided service with a personal touch, has become irrelevant?
Family doctors of good old days relied on what is called physical or clinical examination of patients. With their experience, they could diagnose a patient’s disease, dispense medicines and that was good enough for the patient to get well.
As I see it, today reference to a specialist (often a post graduate, MD or MS) has become an indispensable part of medical practice and as a result the role of the family doctor is shrinking. What has changed?
Obviously there are fewer and fewer doctors, perhaps an insignificant minority in the medical profession, who think that diagnosis and treatment based essentially on physical or clinical examination, is good enough. Today new, advanced equipment is available for diagnosis. Doctors have become more dependent on results of pathology and other external tests. With increase in population, the number of new patients, who may not be living in the immediate neighbourhood, is increasing. Personal bond between doctor and patient is fast disappearing as new patients unknown to the doctor visit his dispensary perhaps never to come back again. scenario today is radically different. Question then is should the medical profession make efforts to save institution of family doctors?
It is interesting to note here role envisaged for ‘Family physician’ by American Academy of Family Physicians. According to this Academy, family physicians are qualified to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age or type of problem, be it biological, behavioural, or social. Though conditions in America and our country are totally different, I think the role considered relevant for a family physician in America is not very different than the role played by our family doctors.
If the institution of family doctor is to be strengthened, what needs to be done? I think, what is needed is continuous up-gradation of professional knowledge and skills of the family doctor. There should be efforts to provide this facility to do that.
I consider a family doctor to be an unsung hero of the good old days. This piece is devoted to him.
Narendra M Apte, a qualified Chartered Accountant, is a freelancer.