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The good doctor

Being primary healthcare providers, GPs have a wide base of people to cater to for treatment as well as prevention of disease, writes Rahat Bano.

education Updated: Sep 22, 2011 12:00 IST
Rahat Bano

A sore throat, stomach cramps, a rash, the runs … and where do you rush to? Chances are, to your friendly neighbourhood GP.

A general practitioner (MBBS) or general physician (MBBS and MD in internal medicine) provide medical treatment to millions of patients every day. Being primary healthcare providers, they have a wide base of people to cater to – across all age groups and ailments – for treatment as well as prevention of disease.

General practitioners can either have their private clinics or get employment elsewhere. They work in municipal dispensaries and polyclinics, hospitals, large companies and other big organisations such as universities and schools and also the food industry. Even the president of India has a physician and a deputy physician based at the Rashtrapati Bhavan. Some guesthouses and hotels empanel doctors to attend to guests, when needed. Food companies and restaurants are required to screen their staff before employment to rule out various conditions such as tuberculosis and certain stomach ailments, adds Dr Pawan Khanna, a general practitioner with an MBBS plus DMRD (diploma in medical radio diagnosis) and a DCH (diploma in child health) in south Delhi. “Their employees also need to get immunised for typhoid from time to time.”

“The career prospects for a GP are very promising,” says Dr Khanna.

The goodwill the work earns you can send your body’s serotonin (a ‘feel-good’ chemical) levels shooting up. “There is immense job satisfaction in being a general practitioner as one gets to be known to most people in the community and earns a great deal of goodwill,” says Dr Khanna. “One can contribute a great deal for the welfare of society in general by making people aware of the preventive aspects (of healthcare) and leading them to the path of good health.”

While the ubiquitous GP’s profile is the stereotypical good doctor in a small practice with basic medical paraphernalia, there are some ‘unconventional’ GPs, too.

While working on this story, HT Horizons met an internist (MBBS and MD in internal medicine) in an affluent south Delhi colony who consults with families for Rs 700 per consultation, more than that charged by DMs, who are super-specialists. Another one offers his services to a Western food company for medical audits.
This is possible with a basic degree, for, a GP is supposed to be a “general” practitioner. However, these days, some or the other specialisation can give you a leg-up in the market, says Dr NC Majhi, MBBS, a retired general duty medical officer from the Central Government Health Scheme (CGHS) in Delhi.

According to Dr Majhi, now on a contract in the CGHS, “An MBBS degree is insufficient. What one should have is a postgraduate qualification.”

What’s it about?
General practitioners/physicians diagnose and treat common ailments and disorders such as fever, cold and diarrhoea as well as serious diseases such as malaria, jaundice, dengue and chicken pox

Clock Work
A GP’s average workday at the clinic:
10 am: Reach clinic. Consultations
1.30 pm: Lunch
2 to 5 pm: Home visits (if any). Visit to school, corporate, if attached
5.30-8 pm: Back to the clinic for consultations
9 pm: Dinner

The Payoff
In the public sector, the starting salary of a fresh MBBS is around Rs 20,000 to Rs 25,000 a month.
In the private sector, the income depends on your skill and expertise, your clinic's location and any additional assignments (home visits, consultations to schools, corporate houses, or industry)

Skills
.
Good communication skills
. Patience to deal with all kinds of patients
. Understand basic needs of patients and society
. Ability and willingness to keep updating your knowledge and skills

How do i get there?
.
Opt for science (physics, chemistry and biology and/ or English) at the plus-two level
. Do an MBBS programme (four-and-a-half-year) plus compulsory one-year internship and you qualify to be a general practitioner. Or, go for a BAMS or a
BUMS degree
. After the MBBS programme, do three years as junior resident in internal medicine to qualify as MD (internal medicine), which makes you a qualified general
physician

Institutes & urls
. All India Institute of Medical Sciences, New Delhi
www.aiims.edu
. Armed Forces Medical College, Pune
afmc.nic.in
. Maulana Azad Medical College, New Delhi
www.mamc.ac.in
. Jawaharlal Nehru Medical Institute of Postgraduate Medical Education and Research, Puducherry
www.jipmer.edu

Pros & Cons
.

Very satisfying job


.

The neighbourhood/family doctor is respected in society


.

There’s good scope for earning good money


.

In private practice, you can decide your work timings


.

Be on call 24 hours a day

A GP is a service provider 24/7

They will become the first contact point for patients

What’s your description of a general practitioner/ physician?
General physicians provide continuing, comprehensive health care to individuals and family. The scope of a family physician (and) general practitioner encompasses all ages, sexes, each organ system and every disease entity. In health care delivery, they are the first point of contact. They provide personalised care. They facilitate preventive, curative and promotive health care and are patient-oriented.

General practitioners work on the principle of community orientation, comprehensive care and co-ordination of care, with cost-effective strategies.

What’s the difference in the services/duties provided by general physicians and general practitioners? In India, do you see any difference in their roles/responsibilities?
General physicians in India are supposed to be postgraduates in medicine and the scope of their work is usually pertaining to medicine and not of surgery, gynaecology or other allied specialities or superspecialities of medical sciences.

With the fast development of super-specialities, the scope of work has reduced for general physicians, especially related to cardiology, respiratory medicine, gastroenterology, endocrinology and oncology. Still at the secondary level, general physicians have to work for these specialities, too.

Other than the usual set-ups in the government and private sectors, what are the different employment options for general physicians and practitioners?
Some of the government and private institutions have their own general duty doctors or physicians, appointed on a regular basis, who provide healthcare to them and give necessary referrals to specialists as and when required. Most hotels empanel doctors who are on call and asked to attend on a ‘need basis’.

Are the entry study routes (mentioned in the box on page one) okay for a general practitioner and general physician, respectively?
Yes, but some of the subjects like the concept of family medicine, medical ethics, geriatric care, personality development, issues related to access, equity, and quality of health care delivery are to be incorporated in the curriculum.

What aptitude and traits should an aspiring general practitioner have?
He should understand well – what is curable, what is tolerable, what is normal, what is preventable, and when the case is to be referred to a specialist and where. He lives in the community itself, so he is a service provider for 24 hours and for 365 days a year. He provides care from womb to tomb. He is a friend, philosopher and guide of the patient and serves family as a smallest unit of the community. He has the knowledge of the disease patterns of the community but he requires academic updates of new skills and practices in medical science.

What are the pros and cons of being a general practitioner in India?
A day will come in the forthcoming era of health insurance when the first contact of the patient will be the general practitioner and only then will the case be attended to by a specialist. General practitioners are to be trained for the primary care system and the specialist for secondary or the tertiary care set-ups.

Dr PC Ranka Interviewed by Rahat Bano