Dr. P K Sasidharan
Till 1960, majority of MBBS doctors somehow continued to work as good GP doctors. Since the government did not have a policy and may be because of neglectful attitude to the British system (which in fact is the base model for health systems across the whole developed world) and the unscientific love for traditional practices and super specialties alone in India, the government did not make a policy for improving our health system with strong base with trained GP doctors.
Due to the undue and premature craze for single system specialisation (which guaranteed ease of work, more income, more reputation and less trouble), over the last six decades, almost all the GP doctors have disappeared, and we kept on promoting specialisation and super-speciality hospitals. Since there are not enough trained and experienced primary care doctors in the periphery, patients started attending bigger hospitals for their primary care (which would naturally be fragmented and disorderly is another issue).
To cater to this increased need for specialists, the government and private entrepreneurs kept on building tertiary care centres. With the result there was an artificially increased need for specialist doctors for the mushrooming numbers of tertiary care hospitals. Ironically to help them, the continued neglect of social health needs ensured supply of enough and more patients, since diseases kept on multiplying to feed these mushrooming hospitals too.
All the bad trends happened when India had the infrastructure needed, but we never prepared doctors truly made for India, instead we planned and executed medical education to cater doctors for hospitals and the western countries. What India needs is trained and motivated GP doctors (family doctors) occupying all the PHCs. The only objective of an MBBS student presently is to get a PG degree in one other or other speciality or to go abroad and they do not do justice to the people, the medical profession and the genuine objectives of MBBS.
There is a phenomenal waste of manpower and money now. This situation has created an artificial market for traditional practitioners and more and more superspecialist doctors. It is ironic that after MBBS, the young doctors are made to waste their time in entrance coaching centres, which results in at least partial or complete loss of whatever little clinical skill, they had acquired during MBBS. At any time, the services of around 50,000 young doctors are made unavailable or wasted in the entrance coaching centres.
If we need to take India forward, we need to have strong policies, made with an iron hand, for making general practice more attractive by offering higher remuneration, more opportunities and offer them appropriate training after MBBS to make them useful to our people.