You don’t need to survive a misadventure at a super-speciality hospital to realise that the “super” tag doesn’t always mean better. Hospitals offering advanced care are needed for media emergencies such as accidents, heart attacks, stroke and cancers, but for minor symptoms like fever, its best to first go to a family physician.
So found Mahesh Tyagi, a 32-year-old chartered accountant who got the correct diagnosis for chronic fatigue and increasing breathlessness after visiting four specialists. “I visited more super-specialists in a week than I have done in a lifetime,” Tyagi recalls.
The pulmonologist said it was a lung problem and so Tyagi underwent chest X-ray, a pulse oximetry and a sputum test, the cardiologist made him undergo a barrage of tests including an echocardiogram and a treadmill test before announcing him fit, the sleep specialist put him under observation for sleep apnea, and the endocrinologist said it could be a hyperactive thyroid, which meant more tests.
Finally, it was his grandfather’s retired general practitioner who glanced at the blood test reports and pointed out the obvious: Tyagi had a low haemoglobin count of 7.2 g/dL against a normal of 13.8-17.2 g/dL. “The breathlessness and fatigue was caused by anaemia and general weakness following an injury. I was amazed that so many super-specialists had missed it even after going through my case history,” says Tyagi, who is back to his active self following two months of prescription iron supplementation.
Diagnostic tests vs skills
Physicians 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.
“Super-specialists sometimes develop a tunnel vision and focus on their speciality instead of treating symptoms holistically,” says Dr Anoop Misra, who was a professor of in the department of medicine at the All India Institute of Medical Sciences (AIIMS) before becoming the chairman of the Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases & Endocrinology.
Family physicians 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.
Specialising means growth and career advancement, more earnings and a better understanding of a branch of medicine, but things can go too far. All doctors are internists first, but as they train to become specialists and super-specialists, some get rusty on the basics because they end up examining patients with disorders related to one branch of medicine.
Short cuts don’t work
Most patients 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.
It’s not that physicians worth hasn’t been recognised. All hospitals have a department of medicine, but most patients choose go directly to specialists without referral because they assume a specialist would know better. Also, skipping referrals saves time and money on consultation fee, which are added incentives for patients.
But things can go wrong, as they did with Tyagi.
“Referral is needed in 10-15% cases only, and close to 90% of daily ailments can be taken care by a general physician,” said Delhi health minister Satyendra Jain, who plans to set up 1,000 mohalla clinics and 150 polyclinics in Delhi by the end of 2016 that offer free physical check-ups, 406 essential medicines, 200 basic diagnostic tests and free routine immunization. “These will refer only those patients who need advanced treatment and care to super speciality hospitals and in doing so, free up specialists and beds for those who really need it,” he said.
Doc on call
Five things to keep in mind when choosing a family physician:
1. Choose someone who is close to your home.
2. The doctor should be on call all the time. Since house calls are often not possible, (s)he should be available on the phone, whatsapp or text to guide you during an emergency.
3. The doctor should be attached to a hospital or nursing home so that he can oversee treatment in case you need hospitalisation.
4. Don’t go for someone you are in awe of. You should be comfortable discussing your health problems as it makes diagnosis easier.
5. Visiting the same doctor or clinic helps to keep your health information records in one place. This will help a specialist about your over-all medical history, such as allergies or the medications you are on, etc .
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