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Do you still have a family physician?

Sunday, 23 February 2014 - 8:00am IST Updated: Saturday, 22 February 2014 - 9:04pm IST | Agency: dna

In the time of super-specialisation in medicine and healthcare, patients seem to bemoan the scarcity of the family doctor who cured their sniffles without making them undergo a battery of tests. Where is the general physician now? Maitri Porecha meets the existing few of this dying breed to find out.

Silver haired and impeccably dressed in a crisp white suit, Dr BN Majmuder tends to the a plethora of ailing patients for hours together at his South Mumbai clinic. At the age of 75 years, he is full of energy, making a run to a patient’s house as soon as he receives an emergency call.  

Dr Majmuder has an enviable ‘fan following’, and he looks after close to 10,000 patients in Malabar Hill and other South Mumbai locales. But they don’t make them like him anymore. He is one of the few left of the dying breed of family physicians in the city. Even today, he embarks upon four to six home visits a day to call upon his ailing patients.

For 50-year-old Malabar Hill resident Alia Ansari (name changed) who was on the verge of death, it was one such home visit by Dr Majmuder that saved the day. “Alia had come to seek treatment at my clinic after experiencing bouts of weakness. She was so ill that she fainted in the clinic. After a few minutes, she gained her composure and returned home with medication,” recollects Dr Majmuder.  The very next morning, Dr Majmuder decided to pay her a home visit to check on her. “I asked her son where his mother was. He said that she had locked her bedroom door from the inside and gone to sleep. We broke open the lock, only to find Alia unconscious,” he narrates, adding, “She had slipped into a comatose condition as her blood sugar levels had dropped to treacherously low levels at 32 mg/dl. I instructed Alia’s son to get a jug-full of sugared water. After consuming the water, she started showing faint signs of recovery. It took a lot of effort to revive her. At that juncture, it was impossible to shift her onto an ambulance and hospitalise her. I fear we might have lost her during the transit,” says Dr Majmuder.

The concept of having a family doctor is fast becoming  extinct and home visits by medical experts are a far-fetched dream. “Within the next five years, having a physician attend to your family’s health will almost die entirely,” says Dr Majmuder.

There is a reason for this: According to data obtained from the Medical Council of India (MCI), nearly 42,000 MBBS doctors get added to the Indian pool of doctors every year. Of these, up to 10,000 migrate abroad for fellowships or higher studies. Another 20,000 take up postgraduate courses in India, and close to 2,000 MBBS graduates quit the medical field and venture into allied or unrelated fields. Eventually, a measly 8,000-10,000 take up general medical practice as a profession. “For a country with a population of 1.2 billion people, the number of doctors entering and sustaining in family practice is scarce,” says Dr Avinash Supe, dean, Lokmanya Tilak Municipal General (LTMG) Hospital and Medical College in Sion.

Which is what makes GPs (general practitioners) even more necessary. Dr Anil Manerkar from Vidyavihar, who has been a family physician for over 40 years, echoes the sentiment. Two weeks ago, he saved an 83-year-old woman from succumbing to a heart attack. “I rushed to her house and revived her by administering life-saving drugs. Family physicians are available 24x7 for their patients, while specialists do not make home visits at all, leave aside at odd hours of the night during an emergency,” he says.

Either years of rich medical experience or a specialization in family medicine after the MBBS degree makes for an adept family doctor, opines Dr Jehangir Sorabjee, consultant physician at Bombay Hospital in Marine Lines. “But doctors with years of experience are now aging and will vanish with the turn of a generation. To add to the problem, India does not offer an MD in family medicine,” says Dr Sorabjee. Of close to 8,000 seats that are reserved for a three-year postgraduate course offered by the Diplomate of National Board (DNB), only 5–6% of seats are allotted to family medicine. On the contrary, a postgraduate degree in family medicine is much sought after in western countries.

“In Australia and Canada, medical students are subjected to aptitude tests and rigorous interviews to test their mettle in practical scenarios before allotting them a field of specialisation. India, on the other hand, relies on entrance test marks. But the competitive lot of doctors may not necessarily be the ones who are keen on serving society,” says Dr Supe.  

While the demand of family doctors may be mounting, they are few in supply. Spotting the vast gap between the seething requirement and poor supply of family doctors in Mumbai, officials at LTMG Hospital in Sion have applied to the Maharashtra University of Health Sciences (MUHS), MCI and the state government to start an MD in family medicine. “We will introduce up to five postgraduate seats for the course if our proposal gets the required approvals,” Dr Supe adds.

Civic-run KEM and Nair hospitals, prominent public medical colleges in Mumbai, are also contemplating introducing the course. “We require a doctor in the outpatient department (OPD) to screen patients and ascertain if they require specialised treatment,” explains Dr Supe. “The perils of bypassing a general physician and directly visiting a specialist doctor are immense. Patients are subject to a battery of tests and endless investigations that burn a hole in their pocket.”

Every five years, family physicians are required to get their license to practice renewed from Maharashtra Medical Council (MMC). But this is not easy. There are stringent pre-conditions. They need to undergo a minimum thirty hours of continuous medical education (CME) training and furnish certificates to MMC for licence renewal. Another reason general practice is on the decline is that fresh MBBS graduates avoid practicing family medicine as a career because it pays less.

Dr Majmuder says that the new crop of specialists don’t feel the need to form emotional bonds with their patients like the good old family doctors did. “A family doctor is integrally woven in the fabric of a patient’s home. My duties go beyond medically treating the family. At times, I have to resolve bickering between parents and their children. I have even convinced orthodox parents to understand the radical views of their children. I am more of a family friend to my patients,” he adds.

Doctors feel corporatisation, furthered by the proliferation of boutique and five-star hospitals, has rung a death knell for family physicians. “Specialists and superspecialists in hospitals are narrow focussed. If a patient runs to them for a simple cough, cold or a head ache, they will either order too many investigations or prescribe high-end antibiotics. On the other hand, family physicians know their patient and his or her disease history. They should ideally exist as a buffer between the patient and costly medical care,” advises Dr Supe.  

Dr Majmuder has an awe-inspiring patient list of judges, sportspersons, actors, artists, politicians and bureaucrats, a following he has built over years of hard work. “Don’t go after money. The more you give, the more it will come after you,” he says, as he begins examining yet another patient in his clinic.

Sorry situation
India produces nearly 42,000 MBBS doctors every year. But of these, only 8,000 to 10,000 take up general medical practice as a profession

India does not offer an MD in family medicine. Of close to 8,000 seats that are reserved for a 3-year PG course offered by the Diplomate of National Board, only 5–6% of seats are allotted to family medicine

Another reason general practice is on the decline is that fresh MBBS graduates avoid practicing family medicine as a career because it pays less

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