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The doctor is out

With the family physician now a dwindling breed, who will you turn to when plagued by that persistent cold, asks Sai Raje.

health and fitness Updated: Jan 15, 2009 20:14 IST

Back in the day, when life was a lot simpler (and probably healthier too), a nagging cough or persistent fever was reason enough for a visit to the family physician, just to “be sure”. The doctor, more often than not, had an impeccable memory of your medical history and knew just what would make you better.

If you take a look around your neighbourhood today, you will realise that family physicians are a dwindling breed, a fact reported by the Hindustan Times in July last year. Since then, the number of new, qualified MBBS doctors practising general medicine has dropped even further, according to Vijay Punjabi, president of the General Practitioners Association (GPA) of Mumbai.

“We have been getting only 10-12 new memberships per year in the GPA for the last five years or so,” he says. Of course, not all general practitioners in the city are registered with the GPA. “We have 3500 qualified MBBS doctor members. There may be at least 5000 or more doctors who have not registered with us,” he adds.

A matter of trust
Punjabi, 71, has been a general practitioner in Nepean Sea Road for the last 43 years and has treated two or more generations of the families that still come to him for treatment.

Why do families invest such faith in a physician? It probably has to do with being cared for in what has become your comfort zone over the years. For instance, 35-year-old Shilpa Nagle moved to Borivli from Thane after marriage. But that hasn’t stopped her from making the commute to her family doctor in her old neighbourhood whenever she is ill. The dwindling numbers of family physicians don’t help either.

“It’s just that we haven’t found a good family doctor yet in our new neighbourhood,” she says. “I am comfortable going to my old doctor because I have been going there for years.” Her husband and his parents also still prefer to visit their family physician in Bandra, where they lived earlier.

There are advantages to having a family doctor that no hospital can provide. “Your family doctor is in the unique position of understanding the history of your family’s health,” says Punjabi. “He knows the idiosyncrasies and allergies of everyone in your family from your grandfather to you. He gives you unbiased advice for a reasonable price.” Punjabi’s association with some patients goes so far back that he is now a part of their family ceremonies and celebrations as well.

Turf wars
Yet, as the sharp decrease in new memberships to the GPA demonstrates, not many doctors want to practice general medicine today. “Most doctors aren’t satisfied with an MBBS qualification now,” says Dr Jayesh Lele, secretary of the Mumbai branch of the Indian Medical Association. “Going abroad or specialising further with an MD is a far more lucrative option.” Being associated with one or more hospitals as consultant specialists is also more profitable, another reason why fewer doctors opt to be general practitioners.

No wonder then that specialists are taking over the family doctor’s turf. Even routine treatments like tetanus or vaccination shots that were once handled by the GP are now the domain of specialists, says Lele, who has practising general medicine for 27 years. “A boy who came to me for his vaccinations years ago is now taking his son to a paediatrician for the same job,” he adds.

Shobhana Gupte, a homemaker in Thane, was forced to seek out a specialist when she moved homes recently. “We had a good physician that our family had been going to for years,” she says. “But when we shifted, we couldn’t find a good GP in our new locality. Now, we end up going to a specialist in the out-patients department in a hospital nearby for all our complaints.”

The GP’s trade has also been affected by the fact that medical insurance only covers those costs that are incurred in a hospital. “That deters many people from opting for a GP’s treatment,” says Lele.

Beware the quack
Senior GPs feel that the most unfortunate fallout of the lack of qualified MBBS family physicians is that it has given rise to a number of inadequately qualified doctors and quacks. “Many of these so called doctors aren’t qualified and prescribe medicines which can be quite risky to patients,” says Punjabi.

But self medication isn’t the best bet either. If some rest and good food aren’t fixing the slight fever and the cold is still there at the end of the week, hop over to the OPD at the nearest hospital, despite the bother.