Patient: "Doctor, I am having a cold for the past three days"
Doctor: "Did you get wet in the rain? No? Your brother is having a cold? NO? Oh! It is your sister who got cold first? Yes? fine. Don't worry. Get this medicine from the compounder and take it for two days. See me after that."

The compounder takes out a thin strip of paper, folds it thrice, cuts all four corners with a scissors and then pastes the unfolded strip onto the bottle. That is a Dose indicator. You give something less than a rupee for a bottle of eight doses of some colored liquid. You happily go home, consume the medicine faithfully and perhaps don't go the doctor again because you are feeling much better.

After some days, your elder brother goes to the doctor for a sore throat. The Doctor remembers every ailment your brother has had, every injury and knows all about his health in total. He knows that in your brother's case ordinary sore throat may land him into pneumonia easily and takes him seriously, unlike he did with your cold.

Senior citizens will easily recall scenes like the above from their childhood days.

Such family doctors are simply missing. Nowadays we have only specialists for every ailment. Specialists charge heavy consultation fees and often do not know anything beyond their specialization. The specialist refuses to look at you as a whole, leave alone your family as an integrated unit. He would always refer you to other specialists and relies heavily on test results for diagnosis. As a layman you may be confused whether you should go to a nephrologist or Urologist when you have a problem of passing urine. Because they are supposed to be better equipped, should you suffer more?

Should we not bring back the Family Doctors? You may wonder why. Well, they knew the entire family and their ailments. They could treat you holistically. They knew by heart medicines to which you are allergic. Some even remember your blood group. Most of them tried simple things first. Much of the diagnosis was done relying on physical examination, observation and questioning. Diagnostic tests were minimal. Patients had total trust. They did not charge you a hefty consultation fees. They helped you going to specialist in case there were complications. They were patient and clarified your doubts. The Family Doctor was ready to make home visits if you grand father could not make it to the clinic.

If we somehow bring back the culture of Family Physicians they may be very beneficial in another area. Health Insurance for Senior citizens is becoming a nightmare. Premiums are heavy. No affordable policies are available. "Pre-existing disease" clauses simply make Health Insurance policies useless. Insurance claims are becoming a racket with the collusion of patients and corporate hospitals. Thus caught in this vicious circle, the poor senior citizens spend sleepless nights without any insurance cover.

Family Physicians can act as a bridge. He can provide preventive and first level domiciliary care. He can help senior citizens maintain good health through advice and regular monitoring. He can liaise with Insurance companies and hospitals whenever hospitalization and surgical procedures are necessary. He can minimize diagnostic tests and not yield to the pressure tactics of greedy corporate hospitals squeezing every last pie from the insurance company. Getting second opinion may be easy. There are lots of other things the FP can do effectively nowadays.

Insurance Development Authority of India (IRDA) set up a committee in 2007 under the Chairmanship of KS Sastry. The mandate was to study and recommend steps to be taken by the Government in improving Health Insurance system for senior citizens. One of the most important recommendations relates to bringing back Family Doctors system. Can NGOs take it up with the GOI to consider this issue seriously?



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