India Needs Its GPs, For Healthier GDP…
In earlier days, most of us (much younger than what we are now), used to approach a general (GP) or family physician, when a family member faced any health issue. However now, most of us, simply prefer consulting a super-specialist, at the drop in pulse or increase in temperature !
It’s a Catch-22 situation here. In the earlier times, a medical student started out her / his medical career after completing the MBBS. And after gaining experience, acquired additional medical qualifications in parallel. Now almost every medical student wants to have a super-specialisation to their credit, before starting out their career. And even those families which ideally would be happy with a qualified and soothing Family Physician, just can’t find (a good) one around !
The Family doctor. GP.
Most middle-class Indian families, at least in urban / semi-urban geographies had their familiar (family) “Doctor uncle” or “Doctor Saab”. That individual was also the powerful person who could talk-back to the family patriarch !
Most of the quintessential GPs were kind, good mannered, knew their client families & their detailed medical histories well; so much so, that most GPs would treat 3 generations of the family (Geriatrics to Pediatrics !) at the same time and were seen as an extended family member. With knowledge of the family medical history, they almost replaced the need for formal testing of genetic markers for any medical risks ! In any medical emergency, they would get the relevant specialist doctor to step-in and they provided continuity of care.
Where are those General Physicians (GP) now ? Is it unfashionable or commercially unviable to have a good GP practice, or both ?
A general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.
Indian medical education & healthcare infrastructure
The Indian Healthcare sector has challenges of inadequate distribution of healthcare service providers and the need for low cost (& yet impactful) healthcare solutions for increasing diseases (especially chronic ones). India has a doctor-to-patient ratio of 1:10,189 - much lower than the 1:1,000 recommended by the World Health Organization. India also has a huge shortage of doctors, nurses and paramedics. That our national investment on healthcare is low, would be a “large-understatement”!
At a broad economic level, poor healthcare would mean lower economic output; which would lead to reduced income generation. At individual level, increased healthcare related expenses directly erodes the income-savings potential, impacts consumption levels and even disturbs the family (social) equilibrium. An efficient health-care sector is a prerequisite for a well-oiled economy.
The Indian health-care system has a three-tier structure of the primary, secondary and tertiary care services. By the Indian Public Health standards (IPHS), the delivery primary health care is designed to provide an integrated curative, preventive, and promotive care to the rural population, through subcenter, primary health center (PHC), and community health center (CHC); secondary care is delivered through district and subdistrict hospitals, and tertiary care at regional/central level institutions or super-specialty hospitals.
The primary health centres (PHCs) are often shunned by the middle classes and those socio-economically above; most of the PHCs are in terrible condition in general and they prefer to seek private sector treatment in secondary or tertiary care, even for common and smaller ailments. Only the poorest depend on government-run PHCs, wherein GPs (might) make the referrals. It is time-consuming and person-dependent to expect empathy and actual care and attention !
Indian medical education system does not fully prepare the future doctors to realities of India. Do our future doctors learn how to deal with the issues and challenges of various illnesses frequenting our non-urban areas ? Do they learn how to diagnose illnesses in our rural area patients, without the high-tech diagnostic equipments they have been exposed to, in their training ? No wonder, we find it challenging to get our young doctors to serve patients across length & breadth of the country.
India does not have a formal referral system of healthcare, routed through a general practitioner (GP). In most of the cases, the patients’ families keep trying different doctors, clinics & hospitals until the medical condition improves. Many a times, the gap between misdiagnosis to unclear diagnosis to over-testing to over-medication widens. Also in our society, one of our favourite idea of patient families to cure, is to listen to various (non-medical) “expert” advise and try combination of different medical systems (allopathy, ayurveda, homeopathy, Unani , etc).
To a large extent, a robust public healthcare is heavily dependent on “processes”; to this effect, the Indian healthcare system needs to “up its game” in building lean-processes that are contemporary to the current & evolving needs of the population. Currently it’s that Indian Jugaad, with band-aid approach of what works and what can be filled & billed !
India is a signatory to The Sustainable Development Goals (SDGs) or the “2030 Agenda” - the universal call for action for better health, end poverty and ensure that all people enjoy peace and prosperity. Health is also an essential part of the Sustainable Development Goals (SDGs). The SDG 3.8 target aims to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” In addition, SDG 1, which calls to “end poverty in all its forms everywhere” could be in peril without UHC, as almost 90 million people are impoverished by health expenses every year.
Access to affordable primary healthcare is an essential requirement to achieve universal health care. While many efforts have been done so far, we need to invest lot more capital, human capital and efforts in achieving these SDGs.
Past & present
The undue preference for specialists over general practitioners is a key influence in the steady decline of the public healthcare system in India. While the medical sciences progressed with great pace in the past 3-4 decades, it probably brought in a loss of recognition to the ‘General Physician’ as a practice. Specialists are seen as doctors, while the GPs seem to be unfortunately seen lower in hierarchy.
Even though substantial improvements have been made in health indicators in the last 10 years, the Indian health-care system continues to contribute large proportion to the global disease burden !
The old-school GP approach was to people - to listen, observe, measure, diagnose, prescribe care, and guide to specialised help, only when and where needed; the approach changed from holistic healing of people to specific super-specialised testing & diagnosis of specific organs. This has had an effect in the depersonalisation of healthcare in general; it has also increased health care costs.
Past experiences with different doctors & medical treatments and anecdotal observations seem to influence the potential care of the Indian patient, more than evidence-based medicine. While there are rapid developments in medical sciences, yet we seem to have trouble with fundamental diagnosis, at times ! As a society, we might be over-medicating for common ailments and under-investing in preventive healthcare !
A well-trained GP adds value, as they have the perspective and knowledge of a broad spectrum of diagnostic testing and medicine. They also understand each of their regular patient’s medical history better and their care takes into consideration the biological, psychological, family and social factors relevant to the care of each patient's illness. In short, a GP is the primary medical care provider and can be a powerful societal tool to reduce (undue) crowding at secondary or tertiary centres.
Any negative impact on the productive workforce due to ill-health is a direct impact on the GDP ! We need to get our GPs back, and that can happen only with societal respect of such talent, as well as structural-way healthcare system is (re)designed for efficiency, scale and world-class in innovation. We need quality and right amount of GPs to ensure growth in our GDP.
The author is Corporate Advisor & Independent markets commentator
Twitter : @ssmumbai
