The Family Physician – An Idea Lost to Time?

At our healthcare innovation enthusiasts meetup this weekend we followed up with an important question for all our attendees. What do you do when you just need simple medical advice? One of our attendees who migrated to Pune only recently surprised us by sharing that he calls his family physician back in his home town Satara. That feedback connected together a series of discussions that we’ve been having here around our direction for Savetime.

Many of us don’t have the equivalent of a family physician. It isn’t that we’re invincible, I guess we simply never made the time. Instead, whenever needed we rely on recommendations from parents, friends, especially those who we think know the city better than we do. While their recommendations work well there’s something missing from the larger picture.

Any diagnosis is founded on at least three key factors – your symptoms, medical history and the prevalent medical environment at that time. We’re all accustomed to asking and answering questions about our physiology so that we can get better treatment. A series of questions can help uncover everything from the smallest to the largest of ailments. That’s how primary care works. We rely on this approach as it would be expensive and even undesirable to prescribe all possible tests for every observed symptom.

What sets apart the family physician is the combination of in-depth knowledge of your medical constitution and training across specialties. In many cases, she is aware of the patients medical make up since birth. When a treatment is ineffective, or a diagnosis incomplete or incorrect, she serves as a key part of the puzzle in prescribing the relevant tests, referring you to the right specialist, or coming up with a new line of questions. Even in the case when you don’t have an ailment, as our meetup attendee pointed out, the family physician is there  to answer any questions too trivial for a visit to the clinic.

Recording medical histories digitally can’t fill in the gap left by a family physician entirely. Think of your medical history as if it were a globe. Medical histories depict what the land masses are like. But we still have no clue about the oceans. In other words. What are you like when you’re well? Or, when you’re not seeking medical care? Do you have any conditions that might be mistaken for the symptom of an ailment? Or worse. Do you have a condition that does not have any visible or verifiable symptoms? How does your physiology change throughout your day? Until we figure out how to track and store what easily runs into terabytes of information, the best alternative is always going to be human intuition and a checklist of questions that can help confirm or invalidate the physicians hypothesis.

In popular culture, the television show “House” is a recognizable parallel to this role. The brilliant eccentric Dr. House is the head of diagnostics at a prominent hospital. In order to be on his team (a much sought after position as the show would like us to believe), House requires his doctors to be ok with breaking into the patient’s house to search for clues. As House says, patients Lie about their histories more often than you’d expect, even if they’re dying. While the show is a work of fiction, the practices shown in the show are not entirely so even if they’ve been amplified for dramatic effect. Moreover, House is literally the ‘Sherlock Holmes’ of diagnostics and is presented with incredibly hard medical cases to solve. To have any credibility, coincidence or luck can hardly be convenient crutches for the story writer.

I’m not sure why the family physician isn’t as popular as it has been in the past. Perhaps a busy migratory life discourages the effort that cements this valuable one on one relationship. At this point, a few questions beg to be asked. What if we could reinvent that relationship? Take it with us wherever we go? What if she were accessible 24×7 over phone, sms or email? What if she had the best in class tools and technology to track our physiology? Wouldn’t that be a different, better world?

Santosh Dawara, User Growth at savetime

Santosh drives user growth at savetime and is a tech-entrepreneur. He enjoys creating products that help users think, create and achieve amazing things with the web. An industry veteran, he’s played roles with BlackBerry smartphone makers, Research in Motion and has taken India’s first online movie tickets aggregator live.

Do we care enough?

As an employee at a major multinational in the United States, I remember my first visit to the doctor’s office. I had woken up to a sore throat and visited the doctor the same day. The doctor checked my breathing, took a throat swab, prescribed an antibiotic and sent me on my way. I thought nothing of the visit until I checked the bill to my insurance provider. Imagine my surprise when I saw that my provider would be paying $110 not including the cost of my medicines, or a little more than Rs. 5,800. It left me with an incredibly unsettled feeling and many questions. Nine years after that visit, today a routine primary care checkup in the US costs $176.

As an Indian, I appreciate that a visit to a doctor here in any city costs anywhere between Rs. 50 to Rs. 500 ($10). Incredibly, the quality of primary care we deliver is still the same. I’m also willing to bet that a significant portion of those dollars paid went towards an unnecessary but mandatory test of my throat swab and indemnification of the doctor against the remote chance of me initiating a lawsuit. Such is an environment where fear of legal retribution commands a premium from exactly the same people who it was supposed to protect in the first place.

Which is why it’s a little disturbing to spot a new trend here in India where we irresponsibly name and shame our doctors. Social media and other forms of participative media encourage patients to share their experiences with doctors. Unfortunately, popular review sites are also breeding grounds for negativity where the posters share only their negative experiences.

Mainstream media too plays a significant role in attempting to shame doctors and their profession. I recall an episode of Satyamev Jayate where host Aamir Khan interviewed a family who had lost a dear one to alleged medical malpractice. What was sad was that the Star TV team did not make an effort to ask the doctor at the center of the accusation for his version of what had happened. This isn’t an isolated incident.

Of course, we shouldn’t excuse our doctor’s for their mistakes. Instead, I ask but a simple question- why shouldn’t we investigate and represent facts for what they are before embarking on a public campaign that could destroy a career? My argument is not meant to protect doctors who intend to harm, but for the doctors who had only the best of intentions and have made a mistake. If we judge going only by the outcome, then many of our doctors are guilty for simply practicing their profession. Such is the nature of what they’ve been asked to do.

I’ve known doctor’s to get attached to some of their patients even when it could mean going against what they’ve been taught. The patient could be a newborn, or someone suffering from a terminal disease. Similarly, when all other avenues are hopeless patients can only place their faith in their doctor. Through the eyes of the patient, the doctor truly must play the role of God. How can we expect them to be perfect? In fact, I can imagine that many doctors have a personal ‘near miss’ story where they compromised the well-being of their patient, but a colleague or simply good fortune intervened and the error was found out before it was too late. No one can be expected to humanly perform at the highest levels. Software engineers write bugs, doctors make errors and even voters occasionally regret their choices in leaders. People do fail, and when we do we reflect on our mistakes and feel terrible about them- thankfully.

Here at Savetime, we realize this fact full well. Patients have come to expect our doctors to have the cure, so much so that a job well done is now ordinary. We don’t agree. To fulfill our vision of creating India’s largest platform to bring doctors and patients together – we’re creating tools that will help you share both types of stories- the ones that will give you goosebumps, as well as those stories which you won’t get to hear. Tools that will hopefully help patients relate their experiences carefully. We won’t pretend that we don’t have a role to play. We believe the impact of our work will be felt in raising the overall intelligence of the patient community, better protection against malpractice and most importantly our confidence in the part of the healthcare system that is working well.

We wish all our doctors on Savetime the best for doctor’s day.

Santosh Dawara, User Growth at savetime

Santosh drives user growth at savetime and is a tech-entrepreneur. He enjoys creating products that help users think, create and achieve amazing things with the web. An industry veteran, he’s played roles with BlackBerry smartphone makers, Research in Motion and has taken India’s first online movie tickets aggregator live.