The Indian family doctor………. an institution on the brink of extinction

The family doctor is synonymous with primary health as well as comprehensive health care in India. Scattered all across India, be it towns, villages and even cities, they were always the first line of contact of a patient with the health system. Highly respected, revered, and loved. They came from different faculties of the medical system; some were Allopath graduates, some Ayurveda graduates, yet others Homeopaths and others Unani graduates. Alongside also flourished a breed called RMPs or registered medical practitioners some of whose credentials were definitely doubtful. They had a basketful of varying degrees, MBBS, BAM&S, BAMS, BMS, DAMS, LCEH, BUMS, GFAM, not that the patient ever cared for his family doctors degree, he in fact never even understood what those letters meant. Crosspathy was the norm, each one practiced a mix of all pathies in their endeavor to give their best to the patients. His mode of transport in the towns and cities was invariably the ‘Hamara Bajaj’ scooter and in villages mostly the Rajdoot motorcycle which could take on any terrain.

The family doctor ensured both primary and emergency treatment and continuing medical care to the patient. He knew all his patients well, their families, their economic and social problems, their habits and vices. He knew their genetic dispositions which made diagnosis of any illness very easy for him. The family doctor was perhaps never wrong in his diagnosis. He didn’t need to take any detailed family history; he already knew it. He was well aware of all their dispositions, his hand percussed well, his palpation dug out hidden indispositions; his stethoscope heard any note that was not in tune with good health. His clinical acumen helped him to diagnose perfectly with these few methods and give good and ethical treatment to his patients. In short, he provided for very affordable treatment which was also very easily accessible.

Not for him were the multiple diagnostic tests as of today, only if he was unable to come to a conclusion would he advise any test, definitely not a battery of them. There was a very limited use of technology in his diagnosis.

He would diagnose and treat your fevers, diarrhea’s, respiratory tract infections, urinary tract infections, renal calculi, monitor your pregnancy, any skin infections, in fact he could and would treat everything. He was the jack of all trades, you had a fall, and he would clean and dress it with a jab of tetanus too. If it was a bigger contused, lacerated wound that too he would clean, suture and dress. Any foreign body in the eye, he would easily remove, similarly with foreign bodies in the ear or nose. if you had corns that too would be easily removed by him, so would he easily remove a sebaceous cyst or even a lipoma. Any lady needed an auroplasty, at  that too he was an expert. There was nothing he didn’t know nor could not do and that too for a minuscule payment.  He was the physician and surgeon rolled into one. He would even provide day care if necessary and would administer intravenous fluids. His clinic or dispensary was of mediocre settings, maybe 2 or three rooms. A table, a chair, an examination table, a few posters on the walls, a calendar, stools for his patients. It was a sparse but well-equipped setup. An electric sterilizer in the corner, his shelves would be filled with medicines, cotton, dressing material, suture material, intravenous fluids, iv sets, sticking tape and all necessary accessories. There would be an emergency tray at one corner, a Xray viewer, his stethoscopes, hammer, forceps and scissors all well stacked, a small refrigerator in one corner for the vaccines. In short, he was well equipped to handle any type of patient.

He doubled up as a gynecologist, obstetrician and pediatrician too. Immunization of the children too was his responsibility. As he stocked and dispensed medicines too he was also the pharmacist. Everything under one roof. His patients were a happy lot, after all he was part of their family, and he joined them in their household celebrations as also in their sorrows. He could be called for house visits regularly, he never refused. There were long queues but no prior appointments were necessary. If you had monetary problems, you could pay later or even the kind doctor would many a time just waive it off. He family doctor also gave advise to families on the education of their children, he counseled his patients and family members to give up smoking, alcohol, drugs if they were addicted to it and successfully too. Family squabbles too would be settled by the shrewd doctor. He provided his services for both acute and chronic illnesses. He provided rehabilitation advice and care. The family doctor gave quality time and advises to his patients, he always avoided unnecessary investigations. He was a boon to the community. He was a trusted person. Even if a patient needed a referral to a secondary or higher center, he would facilitate that too. No wonder he was called the family doctor.

But as usual good things never last forever. The early eighties and later decades saw the influx of the specialist doctors. They specialized in different fields. There were physicians, pediatricians, gynecologists, skin specialists, ophthalmologists, ENT specialists etc. Slowly some patients who were better educated and financially stronger began preferring to see a specialist rather than the family doctor. Of course, the specialists too were very good doctors in their respective fields, but they cost more, prior appointments were needed, long lists of tests were asked to be done, yet the patients had the satisfaction of having gone to a specialist to get the right treatment, but at odd times and hours they still rushed to the family doctors in times of emergency.

A foreign body removal from the eye would cost a few hundred rupees at the family doctors place, it cost a few thousands at the ophthalmologist, but the satisfaction that a specialist took it out was in the patient’s mind. Similarly, all the small surgeries and suturing of wounds he conducted very skillfully at nominal cost would cost ten time more at the specialist but the trend had begun, the out flux at least for specialized treatment’s was towards specialist doctors. People began visiting specialists even for trivial illnesses and began killing the concept of the family doctor. Now he had begun losing these patients and with that his skill too in these matters began to rust.

As he started losing these patients it now was affecting him financially too. The newer generations unlike their older generations didn’t think much of the family doctor, they were happy going to specialists and newer hospitals if treatment was needed. Then came the super specialists. DM, McH and what not. They were masters in different systems and organs, heart, liver, kidney, hand foot, neck, spine, practically every part and organ of the body was catered to by a super specialist. Trends kept on changing; now even for a minor headache patients would line up outside the neurologist’s consultation place, any with UTI would travel to a nephrologist, even the slightest burning sensation in the chest would need a visit to the cardiologist. To make matters worse soon came the corporate hospitals which had every faculty under one roof. They offered all diagnostic services too. The hospitals were swanky, centrally air-conditioned with five-star facilities. The financial status of the patients too had improved drastically coupled with it were huge medical allowances paid for by employers and also the insurance policies offered which ensured cashless treatment. All of this led to the declining number of patients going to the family doctor, some of them mostly the seniors silently wound-up business and went into retirement, the middle-aged formed groups to set small size hospitals, younger ones put money into bigger hospitals as partners, slowly the family doctors both in towns and cities began vanishing.

Those old enough had retired, the younger ones had shifted to newer hospitals, the patients lost out, it was their loss, no more the luxury of calling a doctor home to see his bedridden parents, no more walk-in emergency services, no more cheap quality services, no more heart-to-heart talks with a doctor, the patients unknowingly and unfortunately lost out.

It’s not that only the patients have lost out, the health system has lost out. We need a strong primary health treatment base which is both accessible and affordable to patients if we have to lift up our quality of health services and the key to it is the family doctor. Today no doctor seems to be inclined to do this, none is willing to set up a practice as a family doctor, it doesn’t give any good returns in the current scenario. What every new doctor is interested in today is forming groups, opening a new hospital with diagnostics facilities. There is no more any motivation to work as a family doctor anymore.

Urgent steps need to be taken by the government and medical associations to revive this system immediately before it finally disappears. The trust in the family doctor needs to be reinvented to keep the primary health vibrant. Nothing can replace this very important link at the primary level, lets hope the new generation of doctors realize this and develops the ground for a stronger first point of contact for all patients as their predecessors did.

Published by kanilroy

Medical doctor, partly atheist but believes there is a god, anti establishment, renegade, proud to be an Indian, an awakened one,!! Tolerant to criticism

52 thoughts on “The Indian family doctor………. an institution on the brink of extinction

  1. We have truly lost a very important legacy of this concept. FAMILY DOCTOR was a part of the family and should always be.
    Wonderful write up Sir

    Liked by 2 people

  2. It is so true. No a days nobody cares to visit a family doctor even if he has treated them in their childhood days. With the digital age and Google at hand we prefer to google the reviews (which can be manipulated) and visit a Specialist or doctor with high reviews. And as we are progressing there is not much humanity left in anyone so how can the medical professionals be left behind. I think it is really important to have these Family G.P round the corner of every town so the harrassment of the corporate hospitals will end. Also the new GP’s need to have the character which will be a service to humanity not only work for monetary gain. I hope for the best .

    Liked by 2 people

  3. What a wonderful write up Sir and the concept of Family Doctor explained so well !! 👏🏻👏🏻👌🏻👌🏻
    While reading I was really nostalgic as exactly the same was what I saw in my childhood. This true relationship of Doctor n Patient lead to great faith in each other. And that is why incidents of harassment/attacks on doctors was never known 😌😌
    Very nice article n an eye opener for the younger generation Sir.
    🙏🏻🙏🏻

    Liked by 1 person

      1. Anil , I still remember my dad taking me to our family doctor Dr Joshi at Akurdi . I think your dad also might have taken you there as once your dad was with my dad while in the dispensary
        Good write up, but the current generation have trust on google doctor only 😀

        Liked by 1 person

  4. Yea sir, it is true. After reading ur lecture I remind my childhood doctor , Dr Ram , he use to come in our village at every home who need, He even not taking money. Our villagers giving him bhaji, online, jwari what ever they can give. But he was God to us.

    Liked by 1 person

  5. A heart touching article. Reminded me of my family doctor. Exactly as you have said, he was an advisor, not only for medical field but also your career, future and wherever possible.
    A part of your life, a master of all aspects of the treatment needed without the burden of expensive, unnecessary payments.

    Liked by 1 person

  6. True fact.I think we as medical practitioners are responsible for this fate. Newer research innovations concepts in all aspects of medicine made us service providers and our patients as customers leaving behind the old age concept of family doctor ( bond & trust of patient doctor relationship )It can be reversed by mutual trust only

    Liked by 2 people

  7. It’s true. Family doctor can treat about 80-90% of the illnesses family members suffer and he is the only person who can guide a family member if at all any referral is required as he is familiar to the condition of family..

    Liked by 1 person

  8. Sir, I know it very well…becoz my father had given 55years service as Family Doctor..in 5 village regularly…I also use to go with him in vaccinations… on his JAVA bike…

    Liked by 1 person

  9. Excellent review of the situation. Govt. did take cognizance of the situation and initiated DNB/MD Family Medicine course about 2 decades back but, there are few who opt for it. Attempt was to create a General practitioner through a speciality route, which in itself is a contradiction. The subject needs to be discussed on various platforms. Good, you rekindled the topic, hope it reaches clear thinking brains and policymakers…

    Liked by 1 person

  10. Yes, very true the concept of family doctor is started fading day by day… I still remember the doctor used to give that orange color candy after the examination…! Old good times..!
    Thank u sir..!

    Liked by 1 person

  11. Very nice article.. Sir.. Family doctor is back bone support of a healthy family..n importance of family doctor naver change at any situation..so nice info Sir 🙏👍

    Liked by 1 person

  12. फॅमिली डॉक्टर वरील वास्तववादी लेख आहे. ही कन्सेप्ट नष्ट होत असली तरी आजही एखादा डॉक्टर असतोच जो आपल्या फॅमिलीवर उपचार करत असतो, घरातील कोणी आजारी असेल तर सर्वात प्रथम आपण उपचाराकडे त्याच्याकडेच जातो. छान लेख आहे.

    Liked by 1 person

  13. We have a family doctor growing up and he is still a very important person to our family. He is still respectfully called, “doctor garu”.. by us. As illnesses invaded, we did consult specialist doctors and then there were other doctors who were close, since we live in a small town, but that term, “doctor garu” .. is only meant for him. No names required amd yet we all know who we’re talking about. He is the first person my parents would consult to this day no matter what the illness is. He is nearly 80 years old now and still never misses a phone call. He never did house visits but we were welcomed to their home. No arrogance, no superiority complex, just plain brilliance. When asked, he advised us on our lives, careers and health of course. He is admired and loved because he is the kindest non-judgmental person you can ever find in a small town. He knew all about my mother over feeding us with milk, our tonsils, the teeth lost in accidents, our fluctuating weights during teen years, to our latest medical conditions.
    From the stories he tells about our childhood, I sometimes wonder if he knows us better than us.
    He was a pediatrician by profession, and while my parents found him through us, he stayed relevant in our lives all these years even if it’s been 30+ years since he met us the first time.
    It is sad that as a generation, we weren’t able to establish such beautiful relationships with people not related to us.

    Like

  14. Yes sir,
    I experienced this family doctor concept, when I was small child below 10 yrs. I use to run to the Family doctor for medicine for my mother or father or small brother sister.
    Only to tell problem sickness or illness ……
    Take the medicine…..
    Go home ….
    Take according to advice…
    And the illness goes off.
    Great.
    काळाच्या पडद्याआड गेलेला कलाकार….
    My family Doctor

    Liked by 1 person

  15. दक्षिण भारताशी नाळ जोडलेला परंतु मनाने महाराष्ट्रीयन असणारा,चाळीत रहाणारा एक युवक आपल्या शैक्षणिक हुशारीच्या जोरावर खूप अभ्यास करून MBBS झाला. वैद्यकीय क्षेत्रातील अनुभव हळूहळू वाढत गेला आणि चाळीत रहाणारा सर्वसामान्य कुटुंबातील युवक प्रतिष्ठित डॉक्टर म्हणून नावारुपाला येऊ लागला.
    आता ते कित्येकांचे फॅमिली डॉक्टर झाले होते.सर्व सामान्य लहान-थोर पेशंटवर अत्यल्प फी घेऊन, प्रभावीपणे उपचार करणारे *डॉ.अनिल रॉय सर*.
    सामाजिक भान जपणाऱ्या या उत्तुंग व्यक्तिमत्वाची दखल घेत पिंपरी-चिंचवड महानगरपालिकेने त्यांना मुख्य वैद्यकीय अधिकारी या जबाबदारीच्या पदावर नियुक्त केले.आपल्या साध्या सरळ स्वभावाने आणि कार्यकुशल शैलीने त्यांनी अल्पावधीतच आपल्या कार्याचा ठसा उमटवला.मोठ्या पदावर काम करत असताना सुद्धा *सर्वसामान्य नागरिकांना हवाहवासा वाटणारा,त्यांच्या आरोग्यविषयक अडचणींवर योग्य उपचार करणारा आणि योग्य सल्ला देणारा,मार्गदर्शक *फॅमिली डॉक्टर* त्यांनी कायमचं स्वतःमध्ये जिवंत ठेवला….
    *साक्षात धन्वंतरीचा कृपाशीर्वाद लाभलेल्या आमच्या सर्वांच्या फॅमिली डॉक्टरला आदरपूर्वक वंदन…* 🙏🙏🙏

    Liked by 1 person

  16. Tumhi kelelya karyabaddal agodhar tumche manapasun abhinadan. Tumchya kelelya kamababat baryach vela ikale ani vachalele ahe. Ani ek family Dr. Mhanun tumchi patient babat je prem ani atmiyata ahe, ti vakhannya jogi ahe.Apan kelelya kamacha ani karmacha chokh hisheb ha tyachekade god kade asto. Kavlyachya shapane Gai marat nastat. Ashich tumchi Dr. Mhanun pragati hovo n navlokik vradhingayt hovo , hi parmeshwar charani pradhana.

    Liked by 1 person

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