Family doctor: Lifelong companions in health

A family doctor is a doctor of the family. The first point of contact was where every member of the family, irrespective of age and gender, had access to the family doctor. You can say he was the doctor from the womb to the tomb. He would, by training and his aptitude, be working as a friend, philosopher, and guide to the individuals and families attached to them.

From Trust to Technology: The Shifting Face of Family Physicians

Some 67 days ago, all doctors in India, after passing out MBBS, were working as family doctors because they didn't know of any specialized branch. There was no specialty boom. All doctors were working as family doctors. And they were looking after all the problems. In fact, the healthcare scenario,  at least the treatment aspect of it would have been, above was really good at that time.

After some time, because of lack of policies, every doctor started going for specialization. And now there are only specialists and no family doctors left, in India and this scenario is a unique situation in India alone.

Impact of Losing the Family Doctor Culture

We do not have family doctors. People do not have a choice now. They are forced to go to hospitals and do doctor shopping to get their health problems addressed. We do not have family duties; people tend to go to different doctors for each problem. For example, if they go to a cardiologist for a headache, they go to the neurologist.

This kind of activity does not happen in any developed country with a good health system. Since India does not have a good health system and people are allowed to go doctor shopping, and we do not have family doctors too. And finally, people end up having over-investigation, over-treatment, and over-hospitalization. And the health care expenditure is increasing every day, which will not happen if you have enough family doctors.

Can Family Doctors Survive Today’s Medical System

The challenges in India to promote family doctors are, first of all, nobody knows what a family doctor is. Nobody knows what the need for it is. So we need to create awareness on that. That is what I am working on. I try to create awareness on what a family doctor is and why they are needed. And the challenges are so many. Actually, people are treatment-oriented. They do not know the importance of public health.

Also, the doctors who work as family doctors are the ones who have insight into public health issues. Because health is a byproduct of so many public health initiatives. And these insights are got only by the family doctors and specialists sitting in the hospital; they are unlikely to have insight into social issues because their work is focused on certain areas.

So because we do not have family doctors or healthcare and public health is actually going in a different direction, irreparable damage is being done by the lack of having family doctors in India.

The Status of Family Medicine Worldwide

In fact, I have visited several countries just to see how the health system is working in other parts of the world. First, I began with the UK. When I went in 2007, I found the family doctors; they are called GPs. They were offered more salary and more recognition. It is difficult for an MBBS doctor from India going there to become a family doctor because their students, by choice, want to become family doctors.

They are given honor, and they are given more salary and recognition. At that time it was 5,000 pounds for a family doctor when a specialist got only 3,500 pounds. Such a huge difference was there. Naturally, doctors wanted to become family doctors.

In Canada, 60 to 70% of MBBS students willingly take up family practice as their first choice. The remaining people only go to specialties. In the UK, things are under private control. Still, 40% of other doctors still become family doctors there. Everything is private in Sweden, Denmark, Australia, and everywhere. The family doctors are looked upon as the most important doctors. A certain number of people or families are attached to them.

In Denmark, I found that, maybe, around 5000 people are attached to each family doctor. For all their problems, they will go to that particular doctor only, and only if that doctor refers, they have the opportunity to visit a specialist. In Cuba, I found 250 families are attached to one family doctor, and they even make home visits every week. Everywhere, the family doctor is the most important doctor in society.

They are important for looking after the health of the people, promoting health, preventing disease, early diagnosis, and offering comprehensive, continuous, holistic care to each individual and family attached to them. This is an absolutely essential thing that India has to follow.

Reviving Family Medicine: What Lies Ahead

The way forward is — we now have around one lakh MBBS seats, and the government is increasing the specialty seats. It has reached up to 50,000 or 60,000 maybe. Still, we have 40,000 MBBS students wandering, and all these 40,000 students are joining the fresh batch of one lakh MBBS students and competing for 40,000-50,000 seats.

They waste all their time on the coaching. And we do not have family doctors, so we need to train the remaining 50,000 or 40,000 MBBS doctors who pass out every year to become competent family doctors. MBBS is not enough to practice as a family doctor. Even in the past, when all doctors were practicing as family doctors, MBBS was not enough to make them competent to work as family doctors, but they naturally got the opportunity to work as family doctors, and by five years, they became very good family doctors.

The current scenario is different. Students join the medical college without any insight into what a family doctor is. Their only objective is to become a specialist. There is a focus only on entrance coaching, and they come out after MBBS. At that point, they have absolutely no insight into what family medicine is.

They have no clinical skills either, which are necessary for family doctors. So they need three years of intensive training after MBBS. These 40,000 students who do not get an opportunity to get into specialty seats can be trained to become competent family doctors by offering three-year training. We have the DNB Family Medicine program, or we can start MD Family Medicine in all the medical colleges. It is much more important than starting specialty courses.

Every medical college should have a Family Medicine MD course to get recognition — that has to be implemented. So it has to work at the policy level. And the doctor’s mindset has to be changed by teaching the students about the importance of family medicine. The Department of Family Medicine is a must in all the medical colleges to go forward.