Hyderabad: At a time when India, like the rest of the world, is in the grip of the Covid-19 pandemic, bringing into focus the huge inadequacies in the already fragile healthcare system in the country, revival of the family doctor system is one idea which can go a long way in improving healthcare delivery, feels eminent physician P. Raghu Ram.
The leading breast cancer surgeon is of the view that revival of family doctor/general practitioner (GP) system and making them the first point of contact for the patients for any sickness or for preventive visit will ensure that expensive hospital resources are used on those who need them the most.
“The once upon a time ubiquitous family doctor/GP concept has almost become extinct in the country. Most ‘worried well’ who are asymptomatic, and equally, those with minor common ailments rush to the hospitals, which are already overwhelmed with sick patients,” the Padma Shri awardee doctor told IANS.
He cited the 2020 report of the Medical Council of India, which says that around 44,000 postgraduate seats are available for 55,000 doctors who graduate every year.
“In other words, the vast majority will become specialists. It is indeed an irony that the new MBBS curriculum does not even include a mention about the family doctor/GP concept in its voluminous 890-page document. There are not many applicants for the ‘Family Medicine’ DNB postgraduate courses conducted by the National Board of Examinations because the number of centres accredited to train doctors wishing to pursue a career as a family physician are few and far between,” said Raghu Ram, Director, KIMS-Ushalakshmi Centre for Breast Diseases, Hyderabad.
The doctor, who recently received the Order of British Empire (OBE), pointed out that the concept of visiting the family doctor/GP before a patient sees a specialist is the standard practice in the UK’s National Health Service (NHS).
“The GP is the principal treating doctor who manages most minor issues sensibly based upon evidence and refers patients to specialist centres only when needed. An effective primary care sorts the serious from the non-serious by speedy and accurate diagnosis, directs hospital referrals to the most appropriate speciality and ensures that expensive hospital resources are expended on those who will benefit the most,” he said.
Stating that the ongoing Covid pandemic has brought to sharp focus the huge inadequacies in India’s already fragile healthcare system, he said that India must invest in training GPs in addition to popularising and sensitising young impressionable students who have joined MBBS courses about the family medicine concept.
“Furthermore, primary healthcare infrastructure in rural India (where more than 70 per cent of our population resides) must be strengthened so that more patients are served locally by GPs, thus obviating the arduous and time consuming task of travelling long distances for assessment/treatment,” he said.
“GPs must be ‘gatekeepers’ of our healthcare system. They should be the first point of contact for patients for any sickness or preventive visit. The UK’s NHS model of providing universal primary healthcare through public-private partnership (PPP) may be appropriate for adaptation in the Indian context. Most healthcare in India is provided by the private sector and there is a robust potential for private sector involvement in improving primary healthcare delivery in the country,” he added.
Raghu Ram wants to see the Government of India initiate concrete and implementable measures to ensure that the family doctor concept is revived.
“It is time to make primary healthcare in the country more innovative, inclusive, collaborative and sustainable. An important component of the Hippocratic Oath is to ‘keep the good of the patient as the highest priority’ and this landmark step would pave the path in this direction by ensuring well controlled uniform effective healthcare to the citizenry,” said Raghu Ram.
Among the foremost surgeons in the Asia Pacific region, Raghu Ram established South Asia’s first comprehensive Breast Health Centre and founded a charitable foundation to raise awareness about the importance of early detection of breast cancer nationwide.
Immediate past president of the Association of Surgeons of India (ASI), he is a Fellow of the American College of Surgeons and all four surgical Royal Colleges in the British Isles – Edinburgh, England, Glasgow & Ireland.
He was conferred the Honorary FRCS by the Royal College of Surgeons of Thailand (2019), Honorary Fellowship of the College of Surgeons of Sri Lanka (2020), and is the only surgeon of Indian origin in over 100 years to be conferred the Fellowship of the Association of Surgeons of Great Britain & Ireland (2021).