Thread by @docbhooshan

Thank you for your generous response to this tweet.

I am currently writing a blog post on this so I will share link as soon as ready.

Sharing some salient points via a thread here.

https://twitter.com/docbhooshan/status/1314399926080552960

1. A doctor who is available nearby, in person and on phone, 24*7, has good acumen to solve most regular issues and contact with consultants to solve more complicated ones - golden age of family doctors
Important condition - this doctor should come really cheap.

2. This was good in metros till 20-30yr ago. Still works in areas that are semi urban or rural.

3. Few things happened in 30 years that changed this forever -
a. GP model worked well when all remaining medicine was really "surgery" (totally beyond GP's skill set). Now rest of medicine has cought up in big way.
b. Explosion of knowledge in medicine. So "jack of all traits"

can not exist any more. Beyond cough and cold, many things have become complicated and moved to specialist domain very quickly.

4. Aspiration of liberated India drove her to glitzy-er part of medicine. Doctors are no exception. "Shared care" between GP and Specialist - backbone of healthcare dosent happen in India due to our "pay as you go" model.

5. As people started spending ₹250 on a single burger without second thought, GPs who take two digit consulting fees feel unfairlly exploited for their significant contribution.

6. Then add cost of education at private medical college (60% of med grads), sky rocketing real estate cost of clinic, consumer protection act severely punishing doctors for taking ANY risk, 24*7 demands of GP practice and most dreaded thing -

- Home visits (very high risk, hugely time consuming, pathetic pay, very high customer expectations)

These are nails that sealed the coffin.

Presently your typical GP is AYUSH graduate who practices modern medicine and caters to lower socioeconomic class.

Attempt of reviving family practice by introducing DNB family medicine have been largely unsuccessful. As public knows nothing about DNB. They don't know that DNB = MD.

This is by no claim a complete statement on general practice.

Conclusion - Modern healthcare with its serious demanding nature (expertise, specialization, consumer demands, consumer protection law,etc) dosent favour family medicine in our growing cities.

My usual belief - state funded healthcare that is free at point of contact and works only through specific referrals - rests of solid foundation of family doctor.

One thorny issue, un-addressed by all responders - Cut practice.

Some people claim that cut practice is GP driven practice. GP can give excellent care at very cheap rates only because of cuts.

I don't agree with this sweeping generalisation.

I have managed to find many doctors who happily refer without any cut.
And there are GPs who send only their family members to me but never their patients :)

Many of my specialist colleagues report similar experience.

So there are knowledgeable, empathic, dedicated, self-effacing and ethical family doctors around. They keep the flame burning.
They are few and dwindling.
Reinforcement is blocked by aspirations of new consumerist India.

Doctors are same as rest of society.

We don't realise how good something was till it goes away forever.
We, as humans, are designed to put blame on others and not realise our own contribution to present state.

I will end this thread with a rare, once in a lifetime experience highlighting value of a family doctor -

Few years ago a child was referred to me by GP. His problem was easy to diagnose but difficult to explain with his family circumstances. While I was racking my brain, their GP called and requested confidential communication.

He (GP) told me that child has a different biological father! His mother's husband didn't know about this.
Biological father and his family had a inheritable condition that could explain this child's difficulties.

As trusted GP of mother, this doctor provided most important piece of the puzzle. He had consent from the lady to divulge this information to me only.

This is an extreme example shared to highlight how complicated modern specialist driven medicine has become.

GPs are pure gold.
We are losing them irrevocably.
We have nothing else to blame but our collective sleep walking into prosperity.

Thanks for reading.