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 Table of Contents  
PERSPECTIVE
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 81-83

Do we need to call back the concept of family physician?


Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, Sarita Vihar, New Delhi, India

Date of Submission04-Oct-2021
Date of Acceptance12-Oct-2021
Date of Web Publication14-Dec-2021

Correspondence Address:
Ruknuddin Galib
Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, Sarita Vihar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_88_21

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How to cite this article:
Galib R. Do we need to call back the concept of family physician?. J Ayurveda Case Rep 2021;4:81-3

How to cite this URL:
Galib R. Do we need to call back the concept of family physician?. J Ayurveda Case Rep [serial online] 2021 [cited 2022 Jan 27];4:81-3. Available from: http://www.ayucare.org/text.asp?2021/4/3/81/332439



The role of a physician in health care is pivotal and this has been immensely emphasized in classical literature.[1] The world has recognized the duty of a physician to guide and assure the patients in health-care systems. They treat patients with acute disease, reassure patients with self-limiting disease, managing chronic patients, counsel patients with psychological problems, and prevent health problems through involvement in screening programs.

The elaborative description on the doctor–patient relationship and importance of following ethics while providing health-care services have also been stressed in the classical scriptures.[2] Besides having a rational approach, a physician is expected to be cordial and sympathetic toward his patients. The relationship remains a keystone in patient care.[3] Development of trust enables the patient to comply with the doctor's guidance, frequent visits, and thus consequently results in improvement of health. It allows patients to effectively discuss their health issues.[4]

Conventionally, such physicians are known as family physicians/family doctors. Irrespective of specialization of the physicians, individuals visit them as frequent as needed for their health-care consultations, who will provide primary treatment to address the pathology. Such physicians know the individuals personally having complete information on the health status of the individual. A family physician is aware of the past health conditions, prevalent dietary patterns in the particular demographic region, socioeconomic status, the cultural context, lifestyle of an individual, etc. Considering these, the physician can guide in a better way for dietary and lifestyle modifications, making rational decisions in therapeutics. Having such physicians in life will reduce the health-care costs, precise care, avoid unnecessary diagnostic procedures, and ensure continuity of care.

During 1960s and 1970s, the family physicians were the first point of contact for many families for their health-care problems mostly in the early stages. This trend gradually declined with changes observed in the health-care system and medical education. Advancements in the technologies were noticed and health-care system fragmented into various specialties that slowly created a kind of misperception among the public. Over a period of time, many of us forgotten the family physician and his impact to the society. At present, the health-care system appears to be centered around the tertiary care hospitals and the public started visiting super specialists serving in these tertiary care centers even for their minor problems who prefer treating organs rather than the human body. A shift has been observed from a holistic approach to a system specific in care plan. At times, unethical practices seen raising. Increasing incidences of inappropriate prescriptions, unregulated sales, procuring medicines over-the-counter and their irrational use have been observed in the last couple of decades that have led to antimicrobial resistance (AMR) and associated infections, which emerged as one of the major public health problems in developing countries. It has been reported that physicians receive compensations from pharmaceutical companies in exchange for antibiotic prescriptions.[5] Unfortunately, India is one of the largest consumers of antibiotics worldwide, and antibiotic sale is increasing rapidly.[6] Over-the-counter, nonprescription sales of antibiotics are contributing to AMR in India too.[7]

Despite various initiatives including Chennai Declaration,[8] Red Line Campaign,[9] and a National Action Plan on AMR in 2017,[10] a little progress was noticed due to difficulties at multiple levels. Education of general public and professionals, empowering the public to ask questions regarding the suitability of antibiotics they are being prescribed, media campaigns against AMR and regulation of sales can bring some improvement in the scenario. Bringing the concept of family physician back to the people can immensely contribute in regulating the situation.

Family physicians will have better understanding of individuals in a family and their surrounding social systems and thus can customize appropriate life style guidelines to maintain health and provide primary care for the common ailments avoiding visit to super specialty clinics. They can control spread of the infections effectively in time by educating the families. The recent outbreak, particularly during the second wave, where India was in the grips of a devastating second wave of the COVID-19 virus and cities were facing fresh lockdowns,[11],[12] is a perfect example, where the family physicians would have played a pivotal role.

Trust in a physician is central and a special element in health-care sector. People often trust family physicians and have a direct and easy access with their family physicians. A sense of I trust my doctor so much that I always try to follow his/her advice[13] in the minds of public boost their confidence and make them comfortable to understand the situations better. This further helps them in better coping with disease management. Psychological state of the patient and its direct impact on diseases are well understood.[14]

In general, family physicians have repeated contacts with the families and promote healing through their interactions. They have a clear knowledge about the life cycles, personal and family histories. They can make accurate diagnosis and monitor the health through various levels. Considering the strengths and limitations of the patient, they can suggest when an effective care under the supervision of a specialist is needed. It has been observed that the availability of family physicians in families significantly reduced hospital visits and mortality rates.[15],[16] Their role further can be extended into recommending genetic counseling and offering screening plan to the susceptible family members at risk.

In the current sophisticated world, people lost in multispecialty health-care setting. They need a person who can address their anxieties and guide them to take timely preventive steps to maintain their well-being. Except medical emergencies, a family physician can be an appropriate answer for many of the health-care situations that are creeping into the current scenario. Besides playing a role as primary health-care provider, a family physician can additionally serve as a counselor, health educator, dietitian, guide, friend, philosopher who can add quality to the lives, offering better family health and reducing unnecessary visits to the hospitals. Societies should understand the importance of family physicians and their role in global health care. It is observed that, about 67,000 medical[17] and about 20,000 AYUSH professionals[18] are graduating every year. Can policy makers think on training of these potential health care professionals to specialize them in the field of family physicians? Are we ready to re-invite family physicians into our lives?

Acknowledgment

The inputs and edits of Dr. S. Rajagopala; support extended by Dr. Sonam R Dubey through data collection and Dr. Charu Sharma in proofreading are acknowledged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shastri K, editor. Charak Samhita of Agnivesha, Sutra Sthana. Ch. 9., Ver. 10. Varanasi: Chaukhambha Bharati Academy; 2013. p. 195.  Back to cited text no. 1
    
2.
Shastri K, editor. Charak Samhita of Agnivesha, Sutra Sthana. Ch. 9., Ver. 26. Varanasi: Chaukhambha Bharati Academy; 2013. p. 199.  Back to cited text no. 2
    
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Lipkin M Jr., Putnam SM, Lazare A, editors. The Medical Interview: Clinical Care, Education, and Research. New York, NY: Springer-Verlag; 1995.  Back to cited text no. 3
    
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Chipidza FE, Wallwork RS, Stern TA. Impact of the doctor-patient relationship. Prim care companion CNS Disord 2015;17:10. [doi: 10.4088/PCC.15f01840].  Back to cited text no. 4
    
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Mukherjee R. Can India stop drug companies giving gifts to doctors? BMJ 2013;346:f2635.  Back to cited text no. 5
    
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Dixit A, Kumar N, Kumar S, Trigun V. Antimicrobial resistance: Progress in the decade since emergence of New Delhi Metallo-β-lactamase in India. Indian J Community Med 2019;44:4-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: Drivers and opportunities for action. PLoS Med 2016;13:e1001974.  Back to cited text no. 7
    
8.
Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, et al. “The Chennai Declaration” recommendations of “A roadmap to tackle the challenge of antimicrobial resistance” – A joint meeting of medical societies of India. Indian J Cancer 2012;49:84-94.  Back to cited text no. 8
    
9.
Travasso C. India draws a red line under antibiotic misuse. BMJ 2016;352:i1202.  Back to cited text no. 9
    
10.
Ministry of Health and Family Welfare, Government of India. National Action Plan on Antimicrobial Resistance (NAP AMR), 2017-2021. India: Ministry of Health and Family Welfare, Government of India; 2017. Available from: https://www.mohfw.gov.in/sites/default/files/3203490350abpolicy%20%281%29.pdf/. [Last accessed on 2021 Oct 02].  Back to cited text no. 10
    
11.
India COVID-19 Second Wave: 'A Coronavirus Tsunami we had Never Seen Before' Available from: https://www.bbc.com/news/av/world-asia-india-56747867/. [Last accessed on 2021 Oct 02].  Back to cited text no. 11
    
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13.
Anderson LA, Dedrick RF. Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep 1990;67:1091-100.  Back to cited text no. 13
    
14.
Salleh MR. Life event, stress and illness. Malays J Med Sci 2008;15:9-18.  Back to cited text no. 14
    
15.
Knight JC, Mathews M, Aubrey-Bassler K. Relation between family physician retention and avoidable hospital admission in Newfoundland and Labrador: A population-based cross-sectional study. CMAJ Open 2017;5:E746-52.  Back to cited text no. 15
    
16.
Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA Intern Med 2019;179:506-14.  Back to cited text no. 16
    
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Kumar R, Pal R. India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse!. J Family Med Prim Care 2018;7:841-4.  Back to cited text no. 17
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18.
Chandra S, Patwardhan K. Allopathic, AYUSH and informal medical practitioners in rural India - a prescription for change. J Ayurveda Integr Med 2018;9:143-50.  Back to cited text no. 18
    




 

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