The doctor is no longer in clover — a situation unforeseen by Richard Gordon, famed for his ‘Doctor’ series of novels. This is the family doctor, ready to visit with his black bag whenever called or wielding his stethoscope in his chamber with swing doors two or three houses down the street, cough mixture on the table. The image indicates that his day has passed; the rare family physician these days looks as reassuring, of course, but presents a different picture, in tune with advanced times and smarter medical equipment. Being rare, they are no longer cast in the role of the iconic figure that weaves in and out of stories and films with cures or sad head shakes, free visits, soothing words or a shoulder to cry on. The practice of the ‘general’ physician has been waning for quite a while, since shiny hospitals seething with specialists have taken over the medical space. The new culture has spawned, quite noticeably in India, tiny ‘multi-specialty’ clinics in every locality in place of the ‘GP’s’ chamber. ‘Visits’ are rare; the patient must go to the doctor instead.

This is a loss on multiple levels. The general practitioner was a vital link in the chain of primary healthcare; seeking the right specialist for a headache, trailing numerous expensive tests till the right one is found, is not pleasant. GPs were ‘family’ doctors for a reason: they knew their patients’ illnesses, conditions and allergies, could provide relief from everyday illnesses, and ‘refer’ the patient to a specialist only when needed. They were the gateway to healing. For senior patients, separate specialists for ailments as various as hypertension, arthritis, or asthma, say, mean exertion and expenditure, both difficult, apart from other practical problems such as finding an able companion and the right transport. Record-keeping is neat nowadays, only it tucks away a patient’s lung ailment file in one hospital, his heart’s in another, his knees’ on another floor of the same, with the annex housing his kidney file. This depersonalised approach would have been funny had it not been nerve-racking, if not frightening, for the patient and his carers.

India is packed with specialists it seems, with more graduating every year. Students apparently seek a career with more money and prestige which, they feel, the general practitioner lacks. The local doctor may be loved, but his fees are not a specialist’s fees. Increasing post-graduate seats in medicine match the students’ ambitions; general medicine is not an area of emphasis any more. Naturally, patients too have come to believe that the specialist would offer a better cure than the doctor next door. Countries in the West, however, are trying to reestablish the GP’s position in the healthcare chain; specialist attention for minor ailments, age-related conditions or everyday management that does not need critical care is an absurdity. Maybe the family doctor will knock again on Indian doors too.