Why did My Family Doctor leave? Uncovering the Shift in Healthcare Landscape

During my childhood, we had two family doctors aka general practitioners (GP), one of whom also conducted home visits. I recollect the first few minutes were always spent in exchanging pleasantries, checking on the kids, sharing celebratory & stressful moments. There was a strong connect and innate trust. Money was never the primary discussion at the table. It just exchanged hands with a show of gratitude at the end of the visit. If the medical condition needed a specialist, the GP referred someone trustworthy promptly and put in a word for us. The checkup at the specialist’ chamber was always followed by another visit to the GP who explained the condition, diagnosis, and treatment plan, thereby providing the much-needed assurance and second opinion.

Jan 09, 1988, was a regular weekday morning. I woke up to the sight of my dad throwing up and feeling restless. It seemed like a gastroenteritis episode. After I came back from school, I heard that a neighbourhood doctor had visited and prescribed some antacids since our regular GPs were not available. Since my dad didn’t improve till evening, our reliable Family Doctor paid a home visit. Within minutes, he stated that my dad had a massive heart attack in the early hours of the day and advised immediate admission. Maybe his knowledge of my dad’s medical history of diabetes and hypertension made it easier for his diagnosis. However, we had lost precious hours. What followed was the longest and most intense two months of our life in Mumbai’s reputed and expensive hospitals, till we lost the battle to save my dad. I still can’t fathom how the neighbourhood Doc couldn’t diagnose it correctly. Too late at the Chautha ceremony, we received negative feedback about his competency. At the age of 13, I wished his license could be revoked so he couldn’t harm any more lives.

Looking back, our trust in the medical system was built on “direct feedback” or the “cost of treatment that signalled quality of care”. Since then, there has been a lot of focus on healthcare transformation – but has it really helped? More feedback is available on social or internet, but it isn’t validated. We sign up for expensive health insurance plans to afford top hospitals. However, when we step into the hospitals with highly qualified specialists, best of diagnostics and are greeted by their courteous customer executives there is still a nagging doubt. We seek multiple opinions. Worse, don’t we feel like a Patient Id on the list or income fees on the financial statement of the hospitals? At times, aren’t we tossed around from specialist to super specialist but have no better clarity. As per “The Print” dated October 2020, (https://theprint.in/opinion/bring-back-the-family-doctor-india-has-too-many-specialists/527083/), 81.5% doctors graduating out every year will opt for specialization. Is it surprising when income level, skill demand at hospitals and society respect for a specialist is much higher than for a general practitioner? However, this trend will only lead to further deterioration in trust, additional delays, and higher cost without assurance of better patient outcomes, for those who will be able to afford it. For the rest, it will lead to reduced levels of access regardless of Government funded health insurance which is not sufficient for the hospitals to break even.

In this drive to make high-cost healthcare accessible and affordable, I miss my neighbourhood family doctor. The GP who knows my family medical history, is highly skilled to perform a holistic medical diagnosis, easily available and charges a nominal fee. Does our system have the right balance – are we sufficiently enabling general physicians to set up independent practice, scale up with technology, avail low-cost fund and increase their income?

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