THE RE-EMERGENCE AND THE POWER OF THE GP

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Dr Bijayraj

Sometime during the mid-1990's, the public image of modern medical practitioners in India started getting muddy. Since then, the overall perception of modern medical practitioners has been on a steady decline, despite the great advancements made in the technological aspects of medical science.

This situation is an irony that no one among us- the so-called "cream of intelligence" - had given much thought to.

Why did this happen?

Practitioners loosely attribute it to vicious and relentless slander by the media and general public.

Some others say that the quality of medical education has declined (implying both, poor quality facilities and teachers, in turn breeding young future doctors with poorer attitudes).

Is it simply a co-incidence that the rapid decline in the trust on medical professionals, and the disappearance of the humble neighborhood general practitioner from the 80's and 90's, overlapped?

No, apparently, it is not.

In fact, one may put forth the theory that the disappearance of the GP had a lot to do with the public flogging that most high-flying specialists, tertiary care hospitals, and especially private corporate hospitals get in the present era.

But how could the insignificant GP and reputation of the medical profession, on the whole, be linked? It sounds improbable, impossible.

The answer lies here: When highly qualified specialists of modern medicine started undermining a GP as "just a GP", the slide started.

When young doctors started looking down upon GPs in the 90's, and everyone's sights were firmly set on some glamorous specialty and more money, the slide started.

When no one wanted to be a GP in India anymore, the slide started.

Being a GP meant being consigned to the waste-bin of medical practice.

Being a GP meant you would be a professional nobody.

For a large section of ignorant specialists who placed themselves too high in the clouds, a GP meant "just a GP"- the one who treats minor coughs and colds with saline and little else. The higher one went up in specialized medical studies; and the higher the specialist was placed, the more trivial the GP started looking from those dizzying heights.

A GP was not worth a second look to any 'big' doctor who thinks he/she was 'someone' in the medical hierarchy.

As the modern-medicine qualified GP started disappearing from the social fabric, low-cost, accessible and person-centered healthcare started getting out of reach of the common man. For each disease, each system, and each gender, for each stage of life, the common man was gradually led to believe that you had to show a big doctor of this particular specialty in the big city, or else you would be missing out on something. Several areas, like elderly care, home care, mind-body medicine and even some genders are now ignored and even forgotten since there are no "specialties" for these in India!

Why, it is fairly common even now to hear top modern doctors proclaim during their conference talks that "this patient first went to the local GP who messed up everything". As if the patient survived only because he/she sought out the speaker, who, needless to say, solved "everything" that the patient turned up with. Unwise, unbridled utterances such as these not only sowed the seeds of doubt and rank incompetence among listening practitioners, but also percolated into society via loose gossip.

The void created by the disappearing competent GP was filled in by - guess who?- practitioners of alternative medicine!

How much ever we fret and fume, it is the modern medical fraternity who has to own the blame for 70 percent of Indian primary healthcare being hijacked and now controlled by unscientific medical practitioners- half of whom are unqualified quacks. With every single modern GP taken off the system, it is this alternative, unscientific category that steps in with promises of 'whole person care', 'holistic' care, 'medicines without side-effects' and (surprise, surprise!) two kind words of comfort.

Now the situation in many states across India is of cut-practices, where highly qualified specialists share 10-40 percent of the patient's bills with these primary care referrers- many of them not qualified in modern medicine, but who ultimately decide the fate of the medical system and its 7-star doctors and hospitals. Many of the private hospitals and practitioners have no choice but to swallow their vanity and bend sheepishly to the demands and commands of their referral bases- which is now largely teeming with quacks. Quacks and unethical primary care providers can ruin a decent specialist's practice, or save the career of a crooked one- depending on whether cuts are given to them or not.

And bulk of the naive public still trusts the primary care provider, not the specialist. The public trusts quacks. Yes, that's it.

Had the 'insignificant' GP not disappeared, had people not been led to believe that a top specialist is the only solution for all problems, had young doctors not been brainwashed into believing that general practice is for losers, and had the public not lost faith and trust in their primary care providers, this miserable situation could have largely been averted.

Young doctors now face the brunt for the follies of the previous generation of unwise, ego-centric medical teachers, who were trend setters and role models. And the young generation is now seeking answers from their erstwhile 'role models'.

On the other hand, it is disappointing to see abuse of the word "family" in medical businesses.

As recently as 2019, a group of business-oriented, non-FM trained youngsters from Kerala have claimed to have “innovated” or “re-invented” FM and “are not bothered about money”. They had got their business advertised in a fairly well-known magazine in a disguised article.

Reinvented FM? In 2019?

Several large players before have used similar claims in the last 10 years. There are journal publications about these corporate chains claiming these roles in India. Then how come these young businessmen are claiming to have "innovated" these concepts now, in 2019? What qualifies them to call their business as "family" doctors? MBBS alone? Do they need to be informed that the concept is far more evolved now? Do these businessmen need to be told that now family medicine/ family doctor requires formal training, and has even reached the level where the Government of India has specialty courses and the PG qualification can be registered in the Council? Are they in blissful ignorance, or are they clever, misleading liars? Their quote "not bothered about the money" is paradoxical, since the article clearly mentions that they're into business. Would they do this work if they were told that they should not make a single paisa in profit/salary out of it in their entire career? Many questions; and most answers are unfortunately leading to suspicious intentions in the name of FM. Their advertisement is laced with several underlying abusive vibes. The last line in the ad, about a private hospital charging exorbitantly is also in bad taste. As businessmen, they should have kept in mind the difference between their "cheap" “FM” service (250 rupees is cheap for a shack clinic with MBBS with a 10-day training?!!) and "VALUE for money" (500 is expensive in a 5-star set up with DM level doctors with additional years of experience?)

Pathetic, in one word.

Let's hope it's their naivity or ignorant eagerness making them pass such comments rather than deliberate cunningness and brashness. They've a LOT to learn about basic manners, and basic business etiquette, that's clear so far.

Anyway, all the best to them if their intentions are good.

Editor's notes

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Dr Bijayraj

Family medicine Consultant
Meitra Hospital Calicut

Founder President, AFPI Kerala
email id:bijayraj23@gmail.com