The oft repeated refrain-no holistic approach in patient care
Dr. Ruvaiz Haniffa, in his presidential address at the recently held SLMA conference (as reported in a daily newspaper) bemoans the fact that the holistic approach is lacking in patient care. That is, we fail to consider the patient as a whole, focusing only on the patient’s current complaint.
To my thinking, this is an oftrepeated glib statement.
Let me broadly analyse the medical scene. 80% or more of our patients are treated in Government hospitals--those who require admission are admitted immediately to the relevant ward. The other category are clinic patients who often have to travel many miles, before arriving at the clinic usually between 2 a.m. 4 a.m., so that they are assured of “getting a number”. Exhausted by the time he/she gets to see a Doctor, all he/she wants is a “quick fix”. The Doctor whether it be in the ward or clinic is pressed for time, and can only deal with the ailment the patient presents with.
The more affluent patient consults a Doctor privately, the tendency is to go direct to specialists, who keep proliferating. Here too although time is the governing factor, more communication is possible. If like me, he/she sticks to the same Specialist, with time, a relationship develops, and the approach is inevitably holistic. Unfortunately, most patients tend to go from Doctor to Doctor.
The dearth of General Practioners, (now known as Family Physicians) despite the involvement of the PGIM in their training, is a glaring defect in our health system.
In the fairly distant past, the majority of paying patients would stick to one family Doctor, a General Practitioner. A few outstanding names from the past come to mind-- from Kandy, Dr. Anthonisz, Dr. Wynne and Dr Nihal Karunaratne and from Colombo-- Dr. Frank Gunasekera, Dr. A.D. P.A. Wijegoonewardene, Dr. Mirando, Dr. Muthumani and Dr. Hugh Jayasekera. The services of these doctors were available any time of the day or night. They maintained files on every patient, often extending to the second and third generation. Their relationship with the patient was so much more than the current Doctorpatient one.
Unfortunately, the great majority of “G.P’s” now are medical officers (non-specialists, who may have a diploma in family medicine) attached to government hospitals who see patients after working hours, usually over a fixed period. As such, there is no pride in building up a family practice, together with its connotations.
Perhaps the Ayurvedic Physcians have got it right. Irrespective of the patient’s complaint, a finger on the pulse, will reveal the entirety of the patient’s health status.
To him the ‘ Veda’ (Treatment) and ‘Heda’ (general well-being) aspects are equally important.
Dr. P. Amerasinghe Retired Consultant