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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