Time to have your own family doctor

During my first lecture in medical school we were strongly advised to get our own family doctor if we did not already have one. We were told that even doctors need to have their own doctor. 

So it was a surprise once coming to Jordan that most people do not have a family doctor. In fact, it seems that people shift from one specialist to another for each different complaint, inevitably leaving them with fragmented care, or at times frustrated with multiple different opinions. A friend of mine with a young child-suffering from night-time cough navigated her way through multiple specialists each one saying that the management of the previous one was incorrect, leaving the mother frustrated and confused.

Other friends think it is a waste of time not to go directly to a specialist for the specific care they need. They feel that most primary care doctors would refer them on anyway, so it just creates an extra step in their care. 

In fact, experience and evidence suggests otherwise. A strong primary care system prevents multiple referrals, is much more cost effective and results in better health for the population. 

There are many influences that drive specialisation. One is the vastness of medical knowledge, where it is impossible that anyone can grasp all of it, warranting specialisation. Thus specialist care is a fundamental part of healthcare delivery. However, there are also market influences and cultural influences that push towards the fragmentation of care. We must also remember that the human body itself is not fragmented, and each part, organ or system cannot live or function without the others.

Let’s take the case of a typical patient who comes in complaining of being tired, and wishes to have her blood tested seeking for a cause. I can quickly order some blood tests, which will probably come back with a borderline iron level, then ask about blood loss and diet and put the patient on iron tablets and ask her to come back in one or two months. However, as I know the patient, and also see her children and husband as patients, I am aware that her husband is working abroad, that she is managing her household on her own, and also looking after her sick mother. On further questioning it becomes clear that she is losing interest and her mood is lowering. Her appetite has been decreasing. As a generalist I am skilled in assessing and treating not only the biological health of the patient, but also their psychological and social health. Multiple other issues arise, and care can be given that does in fact promote her well-being, and ultimately the wellbeing of her family. 

In other words, the primary care physician should be a master of the patient, understand their frailties and strengths, and collaborate with the patient to enhance their health. For those of you that already have your own doctor, who you trust and turn to, you can attest to this. For those that do not, it is time to find one. And if a suitable one cannot be found, then patient demand will in time shift the system, so that all can have the benefit of having their own regular doctor.

The writer, who contributed this article to The Jordan Times, is an assistant professor of Family Medicine at the Jordan University of Science and Technology.