The multifunctional family doctor

WORLD FAMILY Doctor Day, celebrated on May 19 annually, is always a very reflective time for me. I started out my medical life exploring a career in general surgery. However, my circumstances changed and led me to work as a family doctor/general practitioner. The lure of general surgery, repairing the human body, the ins and outs of it and the cut and dry of it, tugged at me for several years.

After approximately three and a half decades in the expansive and interesting field of family medicine, I remain befuddled when strangers inquire, “Are you only a general practitioner (GP)?” Many Jamaicans view us as the very basic of our profession. This misconception is not shared by First-World countries. There, the family doctor is at the centre, the core, the hub of all things medical.

In those countries, patients must be managed by their primary-care physician who is responsible for assessing patients and referring if, when and where necessary. Patients who are referred must return to their primary-care doctor for follow-up care and, if other referrals to other specialists are required, the primarycare physician is the doctor who does that.

Here in Jamaica, patients often present with a veritable ‘shopping list’ of problems for the general practitioner to resolve at one sitting. Once, a patient handed me a list of 15 complaints spanning dermatology, the nervous system, orthopaedics, gastroenterology, gynaecology, pulmonology, cardiology, otolaryngology, ophthalmology and psychiatry. Whereas her list was uniquely exhaustive, most patients present with shorter lists covering many complaints.

Our family doctors, or GPs, undertake treatment of most conditions and refer if the problem requires specialist intervention. This is a throwback to a time when the GP managed many conditions, performed a myriad of minor surgeries and even delivered babies. With the growing numbers of specialist and sub-specialist doctors, the role of the GP has become focused on managing patients and/or coordinating specialist management, if and when necessary.

Although we are repositories of information on our patients, one of our major problems/concerns is communicating and networking with some specialists and hospitals. Some take great care to send us feedback on our patients, but most do not, and we end up asking the returning patient what the doctor said and what was prescribed. That leads to inadequate or even impossible follow-up care and we often end up starting over from scratch — which does not bode well for the patient’s health.

As for the hospitals, aside from insurmountable communication barriers, visiting patients is prohibitive. My last horrible experience was at the KPH several years ago. A patient of mine had become critically ill overseas and I had spent several days on the phone, and face to face, with other doctors to get her appropriate care when she was airlifted back to Jamaica. She ended up at the KPH Intensive Care Unit and I attempted to visit there.

The security guards assisted in directing me to where I had to get a visitor’s ID, they even pointed out a staff nurse on her way to work and suggested that I ask her to assist me.

However, instead, she simply laughed, pointed to the throng of people waiting for IDs and wryly said, “Join the line,” as she sashayed away.

Of course, it speaks to the poor attitude of disrespect and dismissiveness that some hospital staff display towards family doctors. It would have taken hours to get in and it was infra dig for me, the patient’s physician who arranged her admission, to join a throng of visitors to seek security permission to visit his patient.

All specialists need to be communicative and all hospitals ought to recognise registered physicians with valid physician’s ID and instruct security to allow us to enter any perimeter gate and access to the wards (even outside visiting hours). Leave the decision as to whether or not the time is appropriate to visit with our ailing patients (and perhaps provide valuable information) up to the nursing staff.

The work of a family doctor is demanding and prolonged, but psychologically rewarding. No profession or medical speciality can replace the family doctor.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.