New special’ mantra for old ills

Problem solved. The bill: Rs 1,800.With patients rushing to consultants for the slightest of ailments, private medical treatment has become phenomenally expensive. Patients who believed that bypassing the family physician would cut treatment costs end up paying consultants far more for professional (read impersonal) diagnosis. Dr Pradnya Pai, dean of KEM hospital and G S Medical college, believes that 70 per cent of diseases can be diagnosed after taking down thedetailed history of a patient, 20 per cent after clinical examination, five per cent by routine examination like X-rays. Only five per cent need sophisticated equipment like CT scan and MRI.

Though a specialist is undoubtedly more qualified than general physicians to treat ailments, rarely does he have the time to take down the detailed history of a new patient. And with no information about the patient from his family doctor, the consultant relies entirely on the patient’s current symptoms for diagnosis. The decline of the family doctor system has reduced general physicians to mere traffic policemen: dispensing anti-biotics for cold, cough and fever.

While middle class patients are ready to shell out upto Rs 500 per visit to a consultant, they do not feel the need to pay a GP for advice. Due to this, the practice of dispensing mixtures and unknown pills in paper packets continues. This in a place like Mumbai where every kind of medicine is available in chemists shops.

In the end, the patient is theloser. Dr Sunil Pandya, Head of department of neurosurgery, KEM hospital said, “Even the Continuing Medical Education (CME) programmes conducted by Indian Medical Associations (IMAs) are poorly attended. Many doctors turn up just before lunch time or utilize the time for sight-seeing at outstation CMEs.”

Cut practice too is rampant, as GPs believe that besides injections, dressing wounds and table mixtures, it is the only way to earn. Dr Pandya suggests that fixing a consultation fee throughout the state or country could solve this problem.

Dr Santosh Karmarkar, paediatric surgeon at the Wadia Children’s hospital also says a short post-graduate course in family practice will help cover more ailments than the existing range. If family practice is profitable, the need for training will automatically arise. The family physician controls the patient’s entry into the health care system and should thus enjoy the trust of the family physician. Dr Karmarkar suggests that hospitals must allow family doctors toattend operations. There is no tab on the number of CT scan/MRI centres in the city, and many newly opened centres create an artificial need for expensive tests. Commissions are paid to doctors who refer patients. There is no restriction on the number of specialists allowed to set up practice in a neighbourhood. The system is becoming top heavy, with family practitioners losing their traditional importance.

A beginning could be made in public hospitals where specialists should be instructed not to see new patients unless first seen by a general practitioner. However, the option of medical insurance also does not seem to attractive except in cases of employee schemes. General surgeon and medical activist Dr Arun Bal points out the drawbacks of health insurance: “Even in the United States, one third of the population is without insurance cover.

Besides, insurance cover entails legal norms which ultimately restrict quality care. For instance, insurance companies insist that a mastectomy should be done on aday-care basis or that mothers should be sent home three days after a Caesarian delivery,” he says.

Dr Pandya, on the other hand, feels that powerful insurance systems will ensure that duplication and conducting unnecessary tests. Insurance companies are very vigilant about the medical bills they pay for.