Family doctors need of the hour

In India, the patients want to see a ‘specialist’ for even the most trivial ailment. As a result, the ‘specialist’ is unable to spend quality time with the patient who genuinely needs his care.

Kerala has emerged as the best state in health care according to the health index launched by Niti Aayog. The report has been prepared in collaboration with the ministry of health and family welfare with technical assistance from the World Bank. The health index is a composite measure based on 23 health indicators with major weightage to the outcomes.

However, a significant number of patients in Kerala are not satisfied with the care given to them. An important cause of this is the very short time a doctor gets to spend with the patient and inadequate communication.

In a recent survey conducted in the USA, 33% of primary care physicians spent around 17 - 24 minutes with their patients; 30% of them 13 - 16 minutes while 22% spent around 9 – 12 minutes. Only 5% of primary care physicians spent less than 9 minutes. On average, they see 20 patients daily. Compare this with the number of patients a doctor in India sees.

Some see 50, some 100 and some over 200 patients daily. This is in addition to the in-patients he has to see, admitted in the hospital. According to a study published in the British Journal of Medicine (BMJ), on average, a doctor in India gets to spend 2-3 minutes with a patient.

Sometimes a doctor sees 2-3 patients at a time. This can result in symptoms getting mixed up, leading to wrong diagnosis and treatment! This can be an important reason why the public is losing trust in doctors and violence against doctors are increasing significantly.

When the consultation time is short, the doctor tends to go over the symptoms quickly. He will not have time to examine the patient in detail. He ends up in prescribing medicines for the symptoms rather than tackling the root causes. It may lead to improper diagnosis. It may not be possible for doctors to advise patients and their family on the nature of their illness, diet to be followed, preventive tips to be taken, and long term consequences.  As a result, patients may get ill again, leading to additional stress on the family and the system.

In India, the patients want to see a "specialist" for even the most trivial ailment. As a result, the "specialist" is unable to spend quality time with the patient who genuinely needs his care.

The need of the hour in India is a good "Primary Care Physician" or "Family Doctor". The patient should go to him for every need (except in the case of an emergency where the patient should go directly to the emergency room of the hospital).

The Primary Care Physician will be well versed with the patient’s past illnesses as well as the illness of his family and relatives. This is very important in the case of chronic conditions such as diabetes, high blood pressure, heart diseases, kidney diseases, etc. If required, the patient can be referred to the "Specialist" with all the details of the illness as well as medicines taken, his working diagnosis, and what he requires. The specialist will then evaluate the patient and refer him back to the Primary Care Physician or Family Doctor with his notes and advise. This will give more time for the "Specialist" to evaluate and treat patients who genuinely require his care.

As a nephrologist, I see over a hundred patients daily. Most of them are stable and come for routine follow up. Many of them come for non-kidney related problems such as cough, cold, backache, etc. Such a visit to the hospital will take up at least half a day or more for the patient; while he gets to spend just around five minutes with me. These patients, if evaluated by their family doctor, can avoid a visit to the hospital.

Another group of patients are those who come to me for "evaluating their kidney" because they want it checked up. It is indeed a good thing for a person to get a regular health check-up done. But it should be done at the primary care level; NOT with a specialist!

If an abnormality is detected, he can be referred to the specialist with a specific letter from the Family Doctor or Primary Care Physician. The patient will definitely be evaluated and referred back.

The need of the hour today in Kerala is a good Primary Health Care system. Every person should be under the care and follow up of a Family Doctor who will be his first point of contact.

He will decide if the patient can be managed by him or needs further evaluation and treatment at a higher centre with a "Specialist". This will reduce the burden on tertiary care centres and doctors will be able to spend quality time with patients. This will go a long way in improving the trust of the public towards health care providers.

(The author is Professor and Head of Nephrology, Amala Institute of Medical Sciences, Thrissur)