Wednesday, September 14, 2011

The Family Doctor

As a boy growing up in the chawls of Bombay, when anyone in the family suffered from a health problem, be it the common cold, fever, cough or minor cuts / burns, the first person to be consulted was the family Doctor – the General Practitioner or GP as he was well known in the medical world then. Such GPs with an MBBS degree and an additional FRCS qualification were found on every street of Matunga, where we lived.

Most of the GP’s landed up converting one of the rooms in their residence into a clinic, with an attached dispensary manned by the ubiquitous Compounder; a breed which has completely vanished today. The doctor would sit behind a table and a long bench adjacent to him was used for the physical examination!

Every time, the patient`s weight would be checked; temperature, BP readings taken and the lungs or heart examined with the stethoscope. Invariably every patient would be asked to open the mouth (say aah!) and put his tongue out so that the doctor could check for tonsillitis or other throat infections. If it was a stomach problem, he would ask the patient to lie on the bench and physically inspect the stomach by pressing the different sections to identify the exact location of the pain or any growth. Then he would pull out a pad and write a prescription and ask you to collect the medicine from the Compounder, whose job was to `dispense` the medicines prescribed by the Doctor.

This guy would take your prescription and vanish behind a partition in the dispensary. He would come back with a standard vertical rectangle shaped bottle containing a `Mixture` (a combination of medicines in liquid form) and a brown envelope containing certain no. of paper packets with either tablets or medicines in powdered form. The bottle would have the dosage indication on a paper label pasted to one side. The label would indicate the quantity of each dosage and the number of doses in the bottle. Very rarely would the doctor recommend branded medicines back in those days!

The patient not only had to wait patiently in the queue for a consultation with the doctor but also wait for the compounder to deliver the medicines. I wonder if the word ‘patient’ was coined by some bright guy, waiting patiently at one such clinic!

If the problem was serious, then the GP would invariably refer him/her to a hospital – private or public for further investigation and treatment by specialists who were available only in the hospitals. Unlike now, where we find specialists for every part of the body, in every street corner in all the cities and towns!!

Apart from the more common Cardiologist, Oncologist, Orthopedic, Nephrologist or even Dentist; we have today under Orthopedics doctors who specialize in specific limbs of the body! A dentist who only does extraction of teeth (Pal Pidungi as he is called in Tamil), while somebody else who is a specialist in root canal treatment.

The danger of going to a specialist directly is that you will be forced to undergo several tests (many of them totally unrelated to the problem under investigation). The specialist gets his cut from the laboratory or the Diagnosis Centre, to whom he refers the patients for tests. Such specialists refuse to accept reports from any other diagnostic centre . Ofcourse, there are good and honest specialists with impeccable reputations but they are exceptions!

An even greater danger awaits an otherwise normal patient who goes for a routine check up to a five star hospital. The check up invariably unearths one or two blocks in the heart and the patient will be offered a package deal; which includes a By-Pass surgery at a concessional rate and also a five star comfortable stay in the hospital for the patient and his attendee. Depending on the availability of rooms the patient will be detained for a few weeks or dispatched home within a couple of days. The poor patient will not be given a choice by the family who would have been already blackmailed by the cardiologist that if the patient walks out of the hospital without undergoing the surgery, he is likely to drop dead at the door step!

My advice to anyone who is willing to listen – please have a family doctor – a GP who attends to all the routine complaints and knows the health history of every member of the family. Even a specialist in your area can become your family doctor. Like my family doctor is a Diabetologist but looks after several families in the area and is available on call whenever a patient urgently needs him. Only if he suggests go for further investigation or consult a specialist referred to. Chances of your getting ripped off by a specialist, when you carry a reference letter from your family doctor are much less than when you go directly. It is another matter if your family doctor is the greedy type, in which case only God can help you!

But even God cannot help those patients who try to get more insight into their problems by `Googling` their specific complaint. They will invariably find that their specific problem could be the indication of some bigger problem connected with anyone or more parts of the body. Armed with the knowledge, the enlightened patient tries to directly consult every possible specialist related to the problem!

Well, you can`t complain against the present medical system, if today`s enlightened patients willingly submit themselves to the exploitation by specialists!

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