Two weeks ago while on a holiday at a rather remote place I happened to meet a person who, on discovering that I was a doctor, said that he had been referred by his doctor after a battery of tests to a higher medical centre for establishing a diagnosis.
After listening to the account of his symptoms, I felt that the diagnosis of the problem was very evident and straight forward. Even a Para-medical worker who happened to be there with us immediately came to the correct conclusion of what the problem might be. But since I did not want to interfere with a case that was being treated by another doctor, I asked the patient to go ahead and get himself investigated fully.
But while pondering over this matter later, I could not help wondering how much family medicine has changed over the brief span of time bet-ween my childhood and adulthood. I also could not help remembering our own family medicine-man who saw us all through our not so infrequent health problems. He was Mysore Venkatsubbaiah Subba Rao whose name was conveniently abridged to 'Subrao Dakatru' by almost all his patients. He actually came to me as a family legacy from our remote village of Aldur perched rather precariously on one of the crests of the many hills of Western Ghats in Chikmagalur.
His visits were something we all used to look forward to as he used to tell us fascinating accounts of how life was during the ‘good old days’ of his youth. After I became a medical student, he would love to exchange notes with me about what was being taught in medical colleges now vis-à-vis what had been taught in his time as a medical student and he would surprise me with the amount of clinical knowledge he possessed despite being only an LMP or Licenciate Practitioner.
His medicines were only a few but his practical knowledge was immense and that was his strongest weapon. He was so meticulous that even in the tiny private clinic that he had set up in his house at Saraswathipuram after retirement he would maintain detailed notes about the symptoms of all his patients and the medicines he had prescribed at their last visit. Investigations were never the forte of medical practice then and all his patients used to seek his services in good faith and absolute trust and would accept his judgment with its limitations.
With old age taking its toll, he faded away from the scene quietly unsung but not without goodwill and gratitude. I still miss him. Now a doctor is not only likely to be considered outdated if he does not show his knowledge of the latest diagnostic tests available but he will also be hauled up before a consumer court for not using them. Establishing a precise diagnosis instead of giving immediate relief from pain with common sense has become the need of the hour. This has ushered in the era of ‘referral medical practice' by virtue of which a patient is shunted from one specialist to another till they all collectively decide that there is nothing seriously wrong! Doctors have indeed become helpless and so I can only say "God help the poor patient."
From Dr Javeed Nayeem's article "Over a Cup of Eevening Tea: The changing face of your Family Doctor" in Star of Mysore.
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