Friday, March 11, 2016

Should in India also, family physician visit be made compulsory for patients, before visiting specialist in routine?

Should in India also, family physician visit  be made compulsory for patients, before visiting specialist in routine?

In India today there is increasing trend or you can say fashion of consulting specialist directly at drop of a hat, especially in major cities.
Irrespective economic status of patients, more and more patients are unnecessarily probably to the extent of about 70% outdoor patients are consulting specialist directly. This especially more prevalent in routine medical patients and children.
Ever for just 1 day or 1 hour old, common aliment like fever, cough, and cold patients just rushed to specialist. This is common with both adults and kids.
It is my assumption that at any given day in most of physicians and pediatrician’s outpatients more than 50% patients are such who do not require specialist consultation or care in outpatient department.
For minor aliments already mentioned to High blood pressure, diabetes etc and in pediatrics vaccination etc which can effectively tackled and managed by a family physician people keep visiting specialists.
This is a dangerous trend for all. The patients are not aware about probable consequences of this like
Ø Increasing cost of healthcare: Obliviously more fees
Ø At times over treatment and over investigations as doctors feel that patient is impatient and his name will be spoiled that even after consulting specialist the patient did not became well soon.
Ø Poor adherence to treatment as lack of time at some bigger hospitals give less time for counselling, more crowded opd and lack of personalized approach.
Ø Poor follow up as, regular visit to a specialist burn a hole in pocket, time consuming.
Ø Early detection of complication is missed, as follow ups are missed.
Ø Close watch on health condition is not possible
Ø Lifestyle modification which is key in most of the lifestyle diseases now, are poorly adhered too as family physician is not involved in treatment who understands all aspects properly including social as well as financial aspects.
Ø Disease diagnosis is delayed, as for minor symptoms patients do not report in time to family physicians
Ø Lack of proper referral advice-as without proper primary examination and history taking, at times many patients lends up visiting wrong specialist or super specialist

The reasons are many.
1.     Ignorance about importance of family physician-primary doctor
2.     To the extent that many even do not bother read the degree of doctor
3.     Fancy of bigger clinics, hospitals which makes them “feel special”
4.     Everybody is in hurry, wants cure of disease overnight without waiting. Wants faster results and magical treatment, with this in mind they visit specialist first.
5.     All parents feel that their kids are special so they only want to see a specialist first for any trivial complaints which in fact may require visit to any doctor at all.
6.     In bigger towns bigger hospitals, one way or other, attract patient directly in name of camp, checkups etc. They are very aggressive in marketing and unfortunately no ethical limitations applies to them in marketing and they use any medium-print,radio,web etc to lure patients directly and indirectly and so called learned patients get tempted to visit bigger institutes.
7.     Half backed online knowledge acquired from unreliable sources. Making them visualize things with magnifying glass
8.     Insurance coverage: Outpatient treatment not covered under insurance, so patients are tempted to get admitted to recover “cost” in illnesses which might extent for a week or two and needs repeated investigations like uncomplicated case of Jaundice, Typhoid, and Dengue etc.
9.     Wrong advise from “super doctors”: friendly neighbor’s, family friends etc who are always ready to lend advice.(At times I really wonder if these people know more than a doctor)
10.                     Many (not all) Consultants are not discouraging such visits. On the contrary many of them want patients to come back to them for any trivial reason even for measuring blood pressure regularly for fear of losing patients.
11.                     Some are undercharging patients, as a part of smart business tactics for the reasons known to all.
12.                     Authorities at all levels are reluctant to anything for this. In fact probably not concerned or bothered about this.


The Result: Current Scenario:

Ø Gross demand supply mismatch.
Ø Growing dissatisfaction against medial fraternity
Ø Healthcare sector is facing many issue
Ø Increasing cost of healthcare
Ø More and more business houses are getting who only see business aspect
Ø In all at the end of day the patients who do not have primary care specialist suffers. We do not have documented date like other countries to prove this at this juncture.
Ø You doctors are not opting for family practice any more.
Ø Underpaid primary care specialist.
Ø Quacks or crosspatch has become remnant.

What could be done to improve this?
Ø Educate society
Ø Mass and ongoing programme for society to educate about various systems of medicine, role of various specialties
Ø Stringent control on sale of over the counter prescription drugs. Even a machine certificate like CAR PUC needs to be taken again after 6 months, in India some prescriptions are valid for lifetime.
Ø All hospitals Government and private must have family physician department who first screen the patients and provide primary treatment and refer only if needed.
Ø Insurance companies need to do some practical ground work
Ø Promotion of specialization in family practice.
Ø No reimbursement of medical bills if consultation or admission is done without obtaining proper reference from primary care physician.(except emergency situations)
Ø Standardization of family practice.

Conclusion: Something seriously need to be done for this. All stake holders’ policy makers, private organization like IMA etc need to seat to gather in find a way out for this.  Education of society is first and foremost importance.


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