6 Glamour versus Value

The Stag at the Pool: A stag felt a sense of pride whenever he saw the reflection of his fine antlers on the surface of a pool. However, he felt ashamed at his slender legs. One day a lion attacked him, but the speed of his legs was more than a match for that of the lion. Unfortunately, his antlers were caught in the branches of a dense forest and the lion pounced on him. The stag thought, "I despised my legs but they almost saved my life. I glorified my horns and they have ruined me."

A) Palani, a rich elderly farmer was status-conscious and proud of his wealth. He always consumed the best in the market, be it food, liquor, smoke or materials for a comfortable living. One of his grouses was that the village lacked specialist doctors. He often used to taunt his family doctor, "Look at the great specialists available in the city. We only have GPs like you in this village.” The family doctor used to say nothing in reply.

One night, while returning home after attending a wedding reception, Palani developed retching, vomiting and stomach ache. He blamed the oily food served at the reception for his current predicament. He ordered his driver to go to the city's top gastroenterology unit for emergency treatment. He was admitted for observation and management. Emergency endoscopy was done and some medicines were given to him for symptom relief.

He went home the next day and had a massive attack with no chest pain but stomach ache. His family doctor came to attend on him. When he recounted the problems of the previous night, the doctor asked him, "Did you not tell the city doctors

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about your smoking, high blood pressure and long standing diabetes? This is an atypical heart attack. You had the warning signs last night."

The farmer was pensive for a while and spoke in a sad voice, "No one asked me anything there. They did all the tests, gave me some expensive medicines and said 'everything is OK in your belly'. I despised family doctors like you but you could have advised me better than the glamorous specialists. I wish I had consulted you last night. I would have got the correct advice and perhaps avoided the heart attack."

B) During the alumni reunion, Shyam, a tertiary care specialist taunted his batch mate Vivek who was a family practitioner. "Look at the glamour in specialities. Why did you end up as a mere GP?" Vivek replied, "I agree your speciality is more glamorous than mine. But when it comes to lifelong rapport with families, wide ranging practice and professional commitment to holistic care, family practice is the best. You all are mere procedural robots who attend to a specific need of a patient at a specific point of time in their life span."

Comments

Specialists know much more about much less. They are essential in providing focused high quality health care to preselected and referred cases. Their services should not be misused by persons with undifferentiated health problems. Undifferentiated problems are initially best assessed by a family physician. "Health care consumption" by direct entry to tertiary hi-tech care causes much 'futzing' (wasteful case management) at times to the detriment of the care seeker.

The family doctors and general practitioners (GPs) have an important function to perform though it may not appear to be as glamorous as tertiary care. They should be proud of their ability to deal with primary undifferentiated patients and sort out their problems in a holistic manner (see Chapter52).

The reality of health care is that the patient care becomes more and more disease oriented and impersonal as you move up to tertiary care. In family practice, diseases come and go but the patients remain with you; in speciality practice, patients come and go but the

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diseases remain with you. "There is a need for schizophrenic practice of medicine. The treatment of a disease may be entirely impersonal; the care of a patient must be entirely personal. The secret of patient care is caring for the patient" (Dr Francis Peabody). A good family doctor can do it well. They are still around.

Get an ethical one for your family today if you do not have one at present.

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