This morning, I had some time to kill as I waited for my passport photos to be printed out. I walked around the rather, spartan local Omaxe Mall, and saw that in addition to the established eateries (Dominoes et al), pharmacies, stationary stores, a brand new establishment has opened –
This is a welcome and much needed service – and I think the first of its kind in our area. This is the new avatar of the traditional general physician or GP, of whom you may have heard, but only seen in old Hindi movies, if you are below 50 years of age. The GP of those times, was a lot more than the first and often the only, port of call for all the ailments of the family. He, very seldom a she, was the depository of all family secrets and a participant in all family decisions. Over time, as medicine advanced, doctors started to specialize – and this shift was unidirectional and unhindered. With the advent of investigation intensive diagnosis, the “Nursing Home’ culture thrived and gradually the stand alone GP was perceived more as a second rate physician, who had failed to specialize, rather than a holistic family healer. The trend was catalyzed by the breakdown of the stable, joint family structure and increasing mobility and migration by job seekers.
Over the last two decades, with the advent of large hospitals and then the multi-specialty corporate chains, the Nursing Homes have also been under pressure especially in large metropolises. They still thrive in smaller cities and towns. The large corporate groups with their sound financial backing, have realized the market potential of these smaller cities. In the meanwhile, public sector hospitals have deteriorated progressively due to lack of financial inputs and governance. Even when there have been money put in to this sector by the Government it has been to upgrade the super-specialty services, rather than the primary care.
So, where has this left the consumer? Most people, delay the visit to the doctor as far as possible – not only because of the cost but also the difficulties in negotiating the hospital. Even the simplest of medical problems, become complex multi-visit exercises with many investigations and medications. The trust deficit, leads to extensive opinion shopping for any diagnosis of a serious nature, further adding to cost. Chronic diseases are poorly managed in this setting and there is no scope for any sort of preventive care.
Into this scenario has stepped in some innovative minds. My good friend, Dr Gautam Sen, started the Wellspring Community Medical Centers in Mumbai a couple of years back and now has 7 clinics in different parts of the city. Many others, realizing both the need and that it need not be poor business, are building these facilities in a for-profit model. Nationwide is one such group, which has 18-20 centers in Bangaluru – I think the one in our neighborhood may be their first one outside Bangaluru. Here the GP does not come to you, as in the days of old, but you go to your neighborhood GP – these centers, hope to get patients and families to register with them and then provide continuous care for all ailments. If consumers feels satisfied with the services, they will return. Loyalty and retention of customers will be crucial as in any other business. Of course, for providing family care, the doctor should be trained as a family physician. This is a well established specialty in most advanced countries – the training opportunity for it are very few in our country. So, I am not sure who are manning this clinic and how it will work. But, at least the model is here – and I do hope it will succeed for only with this approach will any aspect of preventive health reach the population.
So welcome to Family Clinics and I hope it will be a growing tren