Family doctors must be at the heart of a stronger healthcare system in the UAE
▶ Appointments are often made with specialist consultants before visiting a doctor. Shireena Al Nowais reports
A health system that allows patients to send themselves to costly specialists needs restructuring, heads of the UAE’s major hospitals have said.
Some of the country’s top medical professionals warn that patients should have a GP at the heart of their health care.
The benefits of a family doctor are the likelihood of catching illness earlier and building a culture of frequent check-ups – crucial to the early diagnosis of cancer, heart disease and diabetes, all of which the UAE has high rates.
For too long, clinics and hospitals have allowed patients with minor issues to see specialists, said Dr Rakesh Suri, chief executive of Cleveland Clinic Abu Dhabi and one of the world’s foremost heart surgeons.
“I’ve had patients asking me for all sort of things from abdominal pain, from headaches to eye pains. In an integrated health network, you see patients routinely when they are well – they get a yearly healthcare check-up, they get the screenings when they need it and, if we detect disease earlier, we prevent disease more effectively,” Dr Suri said.
Healthpoint in Zayed Sports City already employs a GP and family doctor system. It then refers patients up the chain, including to its own three centres of speciality, or to other hospitals.
“The combination of primary health and specialised health is welcomed by patients,” said Dr Mai Al Jaber, acting medical director and a public health specialist.
Dr Al Jaber acknowledged the scale of the challenge, which is regarded as the product of an insurance-based private healthcare system that allows patients to choose their own treatment.
General practitioners should be the first stop in the healthcare system to diagnose illnesses earlier and build a culture of checkups and healthy lifestyles.
Heads of the country’s major hospitals say specialists should not be at the front line of health care.
For too long clinics and hospitals have allowed patients with sore ankles to see consultant orthopaedic surgeons and those with aches and pains to top specialists, they said.
“I’ve had patients asking me for all sort of things from abdominal pain, from headaches to eye pain,” said Dr Rakesh Suri, chief executive of Cleveland Clinic Abu Dhabi and one of the world’s foremost heart surgeons.
Dr Suri said that after operations, patients were asked who their family doctor was so the hospital could share records and ensure they had regular check-ups.
“They respond, ‘But you are my doctor’ and while it is heartwarming, I still know this is not the best way to have them followed up,” he said.
“The expertise and availability of a general practitioner and a family doctor is what will keep that patient healthy for years, so I am as equally motivated to develop the network of referral.”
Mubadala Healthcare, which manages Cleveland Clinic, is working on a referral system that has family doctors as the first stop. They will send patients with complex needs to specialists if necessary.
Last year, the Abu Dhabi’s Department of Health said it would clamp down on patients referring themselves to costly specialists, to bring down insurance costs.
It will also ensure patients receive regular check-ups, which is crucial for the early diagnosis of cancer, heart disease and diabetes.
“In an integrated health network you see patients routinely when they are well,” Dr Suri said.
“They routinely get yearly healthcare check-ups, they get the screenings when they need it and if we detect disease earlier, we prevent disease more effectively.”
The intention is to “allow people to live happier, healthier and longer lives”, he said.
Stephen Maclaren, a senior executive at Dubai insurer Al Futtaim Willis, said it was common to see patients go for “second, third and fourth opinions from specialists”.
“If people are going from consultant to consultant without seeing a GP first, that is time-consuming and expensive,” he told
The National last year. Healthpoint in Zayed Sports City already has its own GPs and family doctors. If required, they refer patients up the chain to its own specialists or to other hospitals.
“The combination between primary health and specialised health is welcomed by patients,” said Dr Mai Al Jaber, acting medical director and a public health specialist.
“They come to outpatient clinics for primary healthcare services and then are referred to the specialised centres either here or Cleveland Clinic.”
Dr Al Jaber acknowledged the scale of the challenge, which is the result of an insurance-based private healthcare system that allows patients to choose their own treatment.
“In the UAE, the concept of primary healthcare didn’t exist until recently,” she said. “Now the community is gradually getting more oriented on the importance of primary health care and of having a family physician who can solve the majority of their issues.”
Despite growing awareness about lifestyle diseases and the prevalence of cancer, very few people go to the doctor unless something is wrong.
A Cancer Research UK study in 2014 found 46 per cent of cancer patients were diagnosed at a late stage.
For lung cancer, only 23 per cent were diagnosed at stage one or two.
“For a long time we have talked about the need for mammograms and the importance of breast screenings, but still we see cases diagnosed at the later stages,” Dr Al Jaber said. “We are constantly running campaigns but we still see cases who are presenting late.
“Our culture of awareness should start from the school and focus on the importance of a healthy lifestyle, the importance of screenings and the importance of preventive screenings.”
About 80 per cent of Healthpoint’s patients are Emiratis, many with diabetes and high blood pressure.
The hospital is urging this group of patients in particular to have regular check-ups with a family doctor but it remains a challenge, officials said.
GPs and family doctors can also remind patients about their diet and weight, not something they may hear from others.
Dr Kawthar Al Ameri, a family medicine specialist at Seha’s Al Rowda Healthcare Centre, said there was a need to replicate health systems of the UK and Canada.
“The role of a family physician is clearly identified and well practised by patients and healthcare providers, which reflects the family medicine scope of services,” Dr Al Amiri said.
“Whereas in the UAE there is a lack of awareness of the need for regular check-ups.”
But he said that the number of Emirati family doctors was increasing, which might help more conservative families to open up about complaints.
“This will hopefully overcome the obstacles that healthcare facilities are facing,” Dr Al Amiri said.
Experts say that family doctors are specialists who look into the family history of a patient, which is important in a country where genetic diseases, particularly in Emiratis, are common.
I’ve had patients asking me for all sort of things from abdominal pain andheadaches to eye pain
DR RAKESH SURI
Chief executive, Cleveland Clinic AD