|Year : 2017 | Volume
| Issue : 6 | Page : 505-506
Can the family physician make a comeback?
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Web Publication||17-Jan-2018|
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. Can the family physician make a comeback?. Med J DY Patil Univ 2017;10:505-6
Many years ago, as a military doctor, I used to conduct the morning sick parade, the army jargon for outpatient care. I would hurriedly see the patients so that I could go to the nearby military hospital to learn from the interesting cases in the larger medical center.
One day while taking a stroll in the evening, I noticed a queue in front of my office. I walked to the queue to inquire. Being in civvies, the crowd did not recognize me. I was told that “doctor sahib” is attending to patients. I was puzzled. When I mentioned that the doctor conducts the sick parade in the morning, I was informed in a conspiratorial tone that the “doctor sahib” who conducts the sick parade in the evening is much better. The doctor who comes in the morning is no good.
Curiosity aroused I quietly peeped inside. There I saw my medical assistant listening to the patients. He was conversing freely with the troops in their mother tongue. Based on my hurriedly written notes and prescriptions, he would explain the illness and treatment in the language they could understand. In the field far from family and friends, the medical assistant was the friend, philosopher and guide. My technical knowledge was no match compared to this paramedic who could establish rapport with the patients effortlessly. It was a lesson reminiscent of the family physician of an earlier era. I realized that to become a good primary care doctor, I could learn more from this paramedic than from the interesting cases in the military hospital.
The “Good Doctor” is an endangered entity. This doctor was equally skilled in making a diagnosis as in tailoring treatment to each patients' and families' needs. This doctor befriended people understanding that the human connection is essential in managing the disease.
History taking was an art which refined communication skills. This combined with the physical examination established the doctor–patient relationship. The patient was at the center stage of activities related to clinical medicine.
With technological advances driven by specializations and sub-specializations, modern medicine is moving away from this art. Advances in laboratory techniques and imaging modalities make real-time diagnosis feasible. However, the downside is that the modern physician is (literally) losing touch with the patient adversely impacting the doctor–patient relationship.
While technological advances have reduced the clinician's physical touch with the patient, advances in computers and statistical software have driven clinical algorithms based on major symptoms and laboratory results promoting “evidence-based medicine” and a movement to base all treatment decisions on statistically proven data. This has affected the skills of history taking which can help in the diagnosis of atypical cases and outliers. Statistics cannot substitute for human interactions, as it deals with averages, not individuals. Clinical algorithms and statistical evidence do not cover the whole range of social and psychological factors involved in both causation and outcome of the disease.
In response to these trends resulting in alienation of the patient, family medicine reemerged in some countries as a “counterculture” to specialization and super-specialization. We perhaps need today more family physicians to communicate to the patients the treatment advised by specialists and super specialists. This communication would improve the doctor–patient relationship which is at an all-time low.
However, little is being done to enable the family physician to make a comeback in India. There is no undergraduate curriculum in family medicine. Some institutions such as the newly constituted All India Institute of Medical Sciences in some states have clubbed family medicine with community medicine departments. It is debatable whether this can do justice to family medicine or the re-emerging discipline would be smothered in the vast folds of the discipline of community medicine. In that case, it would be very difficult for the family physician to make a badly needed comeback.
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