Kozhikode: The state has to shift the focus from specialty sector to family doctor and family medicine to bring about positive changes in the health care system, according to an expert.
A family doctor is the first person and the best choice to decide the medication for a patient. But the doctors and their organisations in India have not recognised the need for more family doctors, according to Dr P.K. Sasidharan, emeritus professor heading the department of family medicine in Medical College Hospital, Kozhikode, who has initiated a movement 'Social Health One Health.'
Though the number of medical colleges, doctors and hospitals has increased, the quality of public health is deteriorating, he said. "The public do not know what they need for their health care. They accept what is given and marketed as there is hardly any family doctor in India," he said.
The medical bodies are working to bring out specialist doctors overlooking society's real needs. In the developed countries in Europe, all the hospitals are in the government sector. They manage it with the Universal Health Coverage under which everyone has to insure for health in tune with the revenue.
Those who pay Rs 10,000 and Rs 10 lakh get the same treatment. They focus on family doctors to ensure less cost per patient and the right treatment at the right time, he said. In Denmark which has the best healthcare system, each doctor caters up to 5000 people of an area. The doctor will refer the patients to specialists if necessary. "In Canada 60 to 80 percent of undergraduate trainee doctors become family medicine doctors. These countries ensure equal status and better status to family doctors," he said.
The plight of patients in India is that there are "doctors, doctors everywhere, but not a single doctor for common problems and common man," he said. Even in the USA which has the worst health care model, at least 40 percent of all doctors are family doctors, but they work in the private sector without any government support. The poor in the US depend on Cuba for treatment as they are out of the insurance system, he said.
Solutions
To improve the healthcare sector of the state, Dr Sasidharan recommended transforming all fresh MBBS graduates and trainees into primary care doctors or family doctors. All the existing PG seats can be converted to family medicine and more PG courses also can be created in family medicine.
These family medicine doctors will reduce the number of patients as they are trained to look after health promotion, prevention of disease and provide disease care simultaneously in the community setting. They must possess maximum skill compared to other doctors, both clinical and managerial, which cannot be sourced through an MBBS course. They need more clinical exposure after MBBS or should have developed dedicated work experience for at least three years in community setting.
The union government is focusing on family medicine and the state government should do likewise, he said. The family medicine department at MCH, Kozhikode, the first one in the public sector in India, is yet to get a ward as the authorities still feel that it is unnecessary, it was pointed out.
Eminent health activist Dr B. Iqbal, who is also a member of the State Planning Board, told DC that state should promote 'family medicine' concept. The sector focuses on curative and preventive health care while we are now setting up more dialysis centres, operation theatres and ultra modern diagnosis units. A strong family medicine wing can address the health issues of society, make correction at the root and prevent complicated situations for the patients and the public health sector, he noted. More PG courses should be started in family medicine in all medical colleges. Even our well-equipped district hospitals can start courses in family medicine, he pointed out.
