World Health Day 2019: Family physician shortage lowering quality, raising cost of treatment

Today is World Health Day with a focus on universal health coverage, defined as affordable and quality healthcare to all. In India, quality care is often missing, not just in overburdened public hospitals that treat thousands every day, but also in upscale private hospitals, where care is impersonal and profits always come before patients.

A friend with toothache felt disoriented after popping a painkiller and ended up in the emergency of a leading hospital in East Delhi last week. He was given intravenous NaCl (salt), leeched of blood for a battery of tests, which included one to rule out sepsis, and made to undergo an MRI to rule out stroke. It turned out that his “unsteadiness”, the chief symptom in his discharge summary, was because of electrolyte imbalance from dehydration and not having eaten in 24 hours. He was charged Rs 13,551.24 and asked to come back after three days for a neurological evaluation.

This is not an isolated incident of over-diagnosis at hospitals and neighbourhood clinics. When a colleague’s mother had a dizzy spell when she choose to adventurously fast while she had fever, her family took her to another big private hospital in central Delhi. She was prescribed a score of tests and advised to get hospitalised immediately for three days of further tests and medical observation.

A call to the family physician for a second opinion put an end to the panic. The physician promptly said the dizziness was likely because she had skipped her diabetes medication while fasting like she had done in the past, and prescribed a glass of water with glucose. The glucose led to a miraculous recovery and within minutes, she walked back to her car ready to go home even as furious doctors at the hospital insisted she was risking her health and life by going home against medical advice.

In both cases, simply taking the medical history would have ruled out neurological problems immediately. Dizziness is usually caused by dehydration, sudden drop in blood sugar because of fasting or diabetes or both, low blood pressure, migraine, some medications, alcohol, and inner ear-related balance issues. Stroke needs to be ruled out if the dizziness is accompanied with sudden severe headache, double vision, nausea, speaking or walking, or trouble moving the arms and legs.

Family physicians understand each patient’s medical history because of frequent interaction, which allows them to offer a personalised continuum of care to each one. They use their skill to assess the complex interplay of lifestyle, overall physical health and existing chronic diseases like obesity, diabetes and sugar before prescribing diagnostic tests and expensive medication.

Most doctors today choose specialise and work in multiple clinics and hospitals, which has led to family physicians who know their patients’ medical history inside out becoming rarer with each passing day. “People are complicated, and their medical problems rarely come neatly packaged as the single diseases that scientists and doctors study,” says an editorial in the journal Nature last year. Treating illness requires understanding case histories and treating symptoms in combination, which busy doctors in overcrowded hospitals often fail to do.

Around 90% of daily ailments are from minor accidents, like cuts and abrasions, and self-limiting infections and conditions, like diarrhoea, colds and viral fever. Multispecialty hospitals must focus on medical emergencies, illnesses and infections like trauma, heart attacks, stroke, cancers and pneumonia, but unfortunately, highly trained surgeons and emergency care specialists spend most of their time treating fevers and stomach aches.

India had only 1,041,395 registered allopathic doctors in 2017 to treat its population of 1.3 billion people. With 90% of healthcare needs across a lifetime provided by primary health care services, which range from maternity and child care, vaccination, chronic disease management, and supporting care of ageing populations, government initiatives like Mohalla Clinics in Delhi and Health and Wellness Centre under Ayushman Bharat fill a vital gap.

Till these centres are fully operational, however, it’s advisable to identify a family physician who is on call 24×7 — voice call, whatsapp or text — to guide you through a medical emergency. The physicians should also be your go-to person for second opinions and referrals, when needed, to ensure you get unbiased advice if you need more advanced treatment.

At an individual level, each one of us must keep a copy of our medical history, which must include blood group, allergies, past surgeries and major illnesses, and all the medications currently being taken, on the phone. Along with that, those who have health insurance must keep a soft copy/photograph of the health card for easy access during a medical emergency.

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First Published:
Apr 07, 2019 10:22 IST

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