May the GP culture come back

I am always thrilled when I hear of some famous expert saying that something I have been insisting on for ages as necessary to make a better India and a better world has become not only important but urgent. Whether that be a renowned economist or doctor or businessman or lawyer/activist. So I was delighted to read in my newspaper on Sunday the 13th that Andrew Elder, President of the Royal College of Physicians, Edinburgh, has lamented the proliferation of specialists (or, as they say rather ridiculously in India, 'super'-specialists) in the medical profession. It particularly badly affects the elderly, he says, who tend to suffer from multiple problems simultaneously, and running endlessly from one specialist to another is an often very difficult-to-bear drag on their time, patience and purse. No healthcare model, he says, in any country, can deliver the goods for the majority of the population by relying overly on the specialists. The general physician, or, as they used to call him when we were young, family physician, has to come back in a big way.

I have been insisting on this all my adult life, particularly because we in our family have been very lucky: we have enjoyed the invaluable services of excellent GPs almost all our lives. I myself had grown an almost superstitious faith in our own doctor, who had looked after us for nearly forty years before he passed away earlier this year. He only had an MBBS degree, but he was never once wrong in his diagnoses, prescribed very few costly tests, and gave us medicines which worked like charms. I have come to believe beyond the reach of any kind of persuasion to the contrary that a good, experienced, hardworking GP can take care of 90% of your ailments; you should go to specialists only upon his recommendation, and other than in the case of things like heart attacks or liver or kidney failure and serious accidents and major genetic disorders, the 'specialists' can do precious little for you, especially if your time is up, which is generally the case if you fall seriously ill in old age. 

Why has the 'specialist' culture become so widespread? There are many reasons which have worked together and reinforced one another. Only two of them have been mentioned in the above article. One is that young people have developed a childish faith in specialists (ironical, in an age when most of them pretend to be scientifically educated!): 'someone with simple indigestion ... seeks an appointment with a gastro-enterologist'. Another is pure greed for relatively quick money and status, so 'younger doctors almost always want to obtain a specialist degree before they start practising'. True and serious as these reasons are, I have come to be convinced that there are several other reasons, too. One is that - and this I have learnt from some of my best old boys who are now studying medicine - standards of teaching, learning and examination have become so lax that people with just an MBBS (or even MD in general medicine) simply don't have the confidence that they can handle all kinds of patients well: they need to bolster their own egos with one or more additional degrees. Another is that the corporate culture, promising young medical graduates modest but assured salaries, and fabulous packages to 'specialists', has nearly destroyed the ambition of fresh medical graduates to set up their own private practices ... the proliferation of clinical labs and tests has only helped to reinforce the tendency: why learn much of medicine when the tests will tell you everything (and the therapy can be googled)? 

The upshot has been that, as I can see in my own town, private hospitals have become almost as crowded, chaotic and messy as their government equivalents, and people are having to pay through their noses for often highly unsatisfactory, not to say sometimes disastrous, services. I have myself worked hard to find a replacement GP I can trust and respect, I hope he will see me through the rest of my life, and I pray that his tribe may prosper. This much I know: no 'specialist' who gives me all of ten minutes when I visit him for the first time is likely to do better than the GP with whom I can sometimes chat at great length in a relaxed atmosphere, who has treated me for ages, and who knows all my history.