A Family Doctor's Tale - THE FAMILY DOCTOR

 
THE FAMILY DOCTOR

"I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous."
The Hippocratic Oath


When I first started as a family doctor in 1974, the medical doctor was regarded like a fatherly figure to most patients. He was kind, compassionate and caring for his patients and a friend to their family.
It was something I aspire to become.

Not every general practitioner can be a family doctor.
The family doctor knows the family of his patients like the back of his hands.

For example I see the father for his monthly review of  high blood pressure( A Simple Guide to Hypertension), his wife for osteoporosis( A Simple Guide to Osteoporosis), the younger son for weekly injections of vitamin when he was suffering from leukemia( A Simple Guide to Blood Cancer) and undergoing chemotherapy, the oldest son who is married and now worried about finances ( I promised that I will help him out if he does not abort the child) because his wife is confirmed as pregnant. The oldest son now has 2 children of school going age. The younger son whom the father was worried may be infertile as a result of his chemotherapy is now a proud father of a baby boy. The father himself had hoarseness of the voice which after not improving for 2 weeks was sent for biopsy of his vocal cord and found to have cancer of the larynx( A Simple Guide to Laryngeal Cancer). He was treated for this and has been free of cancer for 10 years.

Somehow the family of the patient becomes intertwined with your life and you find yourself asking the patient about his wife, sons and their children each time you meet .That is only one family. 

Another patient whose wife was diagnosed with cancer of the breast ( A Simple Guide to Breast Cancer) after routine mammogram found several lumps in her breast (one of which turned up to cancerous on biopsy) consulted me regarding the removal of the breast which her surgeon wanted to do. It was a small lump which showed early cancer. My advice was remove the lump and then do radiation therapy. However her surgeon thought otherwise and opted to remove the breast. The removed breast was found to be free of cancer. Apparently the cancerous cells had been removed during the earlier biopsy. So an unnecessary major operation

was done . The wife asked me not to tell her teenage daughter about the removal of the breast and up to today her daughter who now has a five year daughter still does not know about her mother's breast removal.
Her husband who had been smoking cigarettes in the toilet for many years subsequently had a bypass operation for his coronary artery blockage( A Simple Guide to Ischemic Heart Disease) . After the operation he asked for me to come to his house to remove all the stitches instead of going to the hospital.
His brother subsequently had cancer of the prostate ( A Simple Guide to Prostate Cancer)and had a catheter inserted into his bladder in order for him to pass urine into a bag. One morning I was called to attend to him because the catheter had slipped out and he was unable to pass urine.
I had to go to the nearest pharmacy to get a similar catheter which can be inserted into his bladder and can be retained inside the bladder. The extent that the family doctor goes out his way to make sure his patient is well showed his commitment to the family and their trust in him.





These are just another example of the trust between the family doctor and the patients. There are many many other families whose trust in their family doctor make us go all out to help and treat them like part of a family.


The family doctor not only diagnose the pregnancy for a newly married couple. He also see pregnant woman for antenatal monthly reviews up to the 5th month of her pregnancy before sending to a obstetrician in a private or public hospital for her further checkup and delivery.

He sees the baby as early as 5 days after their birth for treatment of the baby's jaundice or infection of the navel.

He teaches the mother breastfeeding methods through pregnancy and baby guides published by milk companies and advises on how to feed the child  and burping of the child.
He also follows up with the necessary childhood vaccinations and medical checkups.

As the child grows older, treatment of infectious diseases like influenza, common cold, measles , rubella and mumps follows.

 Once in a while you will have a child with high fever having fits coming to the clinic. These are attended to immediately because of the danger of damage to the brain.

Parents of the children will come to see you occasionally for cold, cough and diarrhea and sometimes conjunctivitis.

Grandparents will see you for old age illness like rheumatism pains, diarrhea or incontinence.

I remember frequent cases where I will have to catherize the patient in order to relieve them of their urine blockage and bloated bladders. Then there are the chronic cases of diabetes, hypertension and strokes.I was often called for house calls sometimes in the middle of the night to attend to febrile fits in children, asthma, strokes, heart attacks and severe infections which prevent them from coming to the clinic.

In the past the family doctor was like a friend to the family. He treats the baby, the older children, the pregnant mothers, working fathers and their grandparents. Even now there are families who still bring their grandchildren to consult me. 
Most of  the family know how to contact me during an emergency.

I know their names and the children's names and also their family situation.

In many cases the patients who are poor are charged a token amount otherwise they will not see you due to their pride. 
They however do not have to pay their medical fees or medicines. 

During our recent relocation of our clinic while going through the medical record cards in order to discard those patients who have not seen me for at least 10 years. I found that there were patients still owing money since 1974 when I first started the clinic. I do not believe in chasing patients for their money.

There was this Indian foreman who was in charge of our estate rubbish removal. He was poor but he brought his family to see me asking the money to be owed. For 10 years he brought his family for treatment . Knowing that he was poor I did not expect any payment for all these treatments. Yet at the age of 55 years ( the retirement age at that time) he was able to withdraw funds from the government Central Provident Fund( A compulsory saving scheme meant for retirement). To my surprise he asked my nurses to calculate all the medical bills over the years to added up so that he can pay the whole sum. It was a pleasant surprise for me.
 
At that time a family doctor was really a family doctor looking after babies, children, pregnant mothers, working fathers and grandparents.

Times have changed since the 1990s. Pregnant women goes to their obstetrician.

Babies and children are treated by their pediatricians.

Working parents are treated by their company doctors.

Grandparents may be treated by geriatricians.

In spite of all these changes there are still many families who still remember their family doctors and come back to us when the other doctor's medicines do not work. 
They know that they can depend on us and can come to us for advice.
That is the essence of a family doctor whose duty is to guide, treat and educate a full generation of patients.