She walked into my outpatient clinic carrying a file thicker than a city telephone directory.
She was forty, stood five-foot-two, and weighed 130 kilograms. Her blood sugars were soaring, her blood pressure was dangerously high, and her serum creatinine—a marker of how well the kidneys are holding up—was creeping north. A recent ultrasound showed her liver was choked with fat.
None of this is rare anymore. In upper-middle-class India, every home now has one.
What made her unusual was her itinerary. She had as many as five distinct conditions, and for each one, she had already seen a distinct specialist: an endocrinologist for the sugar, a bariatric surgeon for the weight, a nephrologist for the kidneys, a cardiologist for blood pressure and a gastroenterologist for the liver.
Over forty years in medicine, I have noticed a direct, inescapable pattern: as your waistline expands and your wallet thickens, so does your medical file. You do not just accumulate extra kilograms and money you don’t need; you accumulate diagnoses. And because you can afford it—and perhaps because you have developed a fashionable skepticism for plain MBBS doctors and MD generalists—you go shopping. You hop from one super-specialist to the next, each a master of a single organ: a heart, a lung, a liver, a kidney.
This woman’s file was a museum of modern diagnostics. It contained hundreds of blood sugar logs, quarterly HbA1c curves, endless creatinine trends, dozens of echocardiograms, and a half-dozen abdominal ultrasounds.
Yet, she was deeply unhappy.
She had not come to me for another test. She came looking for a doctor who would stitch these fragmented reports back together—someone who would look at her not as an assembly line of failing organs, but as a human being whose body had simply lost its rhythm. She wanted someone to prune her prescription list. She was swallowing twenty pills a day. Given the microscopic font the pharmaceutical industry prints on foil strips, she spent half her morning just trying to figure out which pill did what, and when to take it.
“Who,” she asked, “is supposed to look at all of me?”
It is a fair question. Who could that doctor be?
Could it be the MD General Physician? The one who spent years mastering Harrison’s Principles of Internal Medicine, seeing the full spectrum of illness during residency?
Could it be the plain MBBS doctor? Unlikely. Today, almost nobody wants to stay just an MBBS doctor. The degree has been degraded from a proud badge of general practice into a mere pitstop on the long highway to super-specialization—more of a liability than an asset.
Or could it be the Family Physician? That rare, comfortable species that flourished in the India of the 1960s and 70s. Those were doctors who knew not just the human body, but the entire family—the children, the parents, the grandparents. They handled whatever walked through the door. Their prescriptions were modest, their authority was absolute, and their presence alone brought a quiet, therapeutic calm to a household.
When I was growing up in Wardha during the 1960s and 1970s, the town had its own guardians of health. There was Dr. S. G. Gholap near Durga Talkies, Dr. Y. G. Barve and Dr. C. V. Warhadpande near Ingole Chowk, Dr. Mohanlal Vora, whose clinic stood by the Subji Mandi, and—lest I forget—Dr. Ram Akhuj. Each embodied something that modern medicine has all but lost: the family doctor who was not merely a physician, but also a trusted friend, philosopher, and guide. We walked into their clinics with fevers, coughs, stomach aches, sprains, and every other childhood complaint. We usually walked out with a glass bottle of mixture, a paper strip pasted on its side by the compounder, and perhaps a quick shot in the arm. We got better. Not a single blood test was ever ordered.
That kind of family physician has now all but disappeared.
Many MBBS doctors feel under-equipped, and even physicians with an MD in General Medicine can feel overwhelmed by the relentless pace of modern medicine. Every year brings new drugs, new tests, and specialized interventions that were unheard of when they were in medical school. Keeping up with these advances is not easy. Faced with a patient whose problems seem complex, the safest instinct is often to pass the baton: “You should see the specialist.”
The specialist, already busy with a crowded clinic, does what specialists do best. They order more tests, prescribe another medicine, and ask the patient to return for another visit.
The wheel turns. The file grows thicker. The patient gets sicker.
Will this cycle ever stop? I do not know. But as I sat across from this woman, watching her try to make sense of her daily handful of pills, one thing felt painfully clear: we have built a medical system that knows everything about the disease, but has forgotten the person carrying it.
A masterpiece!! It’s so true and relatable.
You are absolutely right. Great write-up, SP. The era of the family physician is largely behind us, but today we need well-trained general internists with an MD in Medicine more than ever.
You are spot on! I’ll include two more doctors in the list: Dr. Vora and Dr. Ram Akhuj.
Sadly, that’s true. Healthcare is increasingly being driven by corporations, and the human touch is slowly being lost.
Friend, philosopher, and guide—the ideal that only a few passionate souls can truly attain. A true deewana. Sachdeva from an MGIMS batch of the 1990s.
Very well written article. Family physicians are indispensable, but so are doctors from every specialty. With a growing population and changing lifestyles, we need all of them. Above all, doctors who practice medicine ethically—whatever their specialty—earn the trust and respect of their patients. That’s what I believe.
The term family physician has almost become extinct. This article rightly highlights the important role of the general practitioner. An excellent and timely article.
India needs a strong, respected postgraduate qualification in General Practice or Family Medicine. In New Zealand, General Practice is recognized as a specialty, and patients consult family medicine specialists who are trained to care for the patient as a whole—much like the family physicians who practiced in India during the 1970s, including my father.
General practitioners here also have opportunities to subspecialize through college-accredited training in areas such as musculoskeletal medicine, obstetrics, child health, and palliative care, while continuing to practice as GPs. It enhances both their expertise and their mana—the Māori concept of dignity, prestige, and self-respect.
The US offers a residency in Family Medicine, and I am proud to say that I chose this specialty. During my residency, I cared for patients across the entire age spectrum—from children to adults and older adults. Family physicians are also trained to conduct normal vaginal deliveries and, in rural settings, often provide obstetric care as well.
We refer patients to specialists when necessary and then integrate their recommendations to provide comprehensive, coordinated care. Sadly, I must admit that Family Medicine is becoming a dying specialty.
Reading this brought back memories of the good old days—days that will never return.
*Koi lauta de mere beete huye din.*
Back then, the family doctor never had to deal with patients armed with Google searches and self-diagnoses. By earning the trust of the family, a good GP managed to treat nearly 90% of common ailments with a relatively limited armamentarium.
I remember a GP who ordered a blood urea test only when he felt the patient was seriously ill. We also had the city’s most respected pathologist, who would personally draw the blood sample. To patients, that simple gesture was the ultimate expression of care and a reassurance that the test would be done right.
Absolutely true. Every town, village, and city is missing such doctors today. In fact, there are only a few people like you who still belong to that rare breed. Sadly, in a few years, this community may disappear altogether.
Perhaps we will have to pray to the Almighty to create and send more such doctors to care for the people He sends to this earth.
Well written. This is the reality that patients have to face. The future appears even darker: the rapid proliferation of medical colleges, increasing admissions at both undergraduate and postgraduate levels, and a growing shortage of qualified faculty. Anyone can foresee the outcome—it is exactly as you have described so well.
So true, Sir! We were so comfortable during our childhood because our family doctor was always there for us—supportive and excellent at diagnosing almost every ailment. Today, corporate hospitals are mushrooming everywhere, and people are often confused about where to go and whom to consult for their health problems.
I think it all comes down to the availability of choices. In the good old days, there were fewer choices when selecting a doctor, and people were more content. Today, with so many specialists, super-specialists, and even ultra-specialists, patients often face more confusion, uncertainty, and dissatisfaction.
General practice in the UK and Australia represents family medicine at its best. It requires a formal qualification after a minimum of three years of structured training across both hospitals and community practice, leading to Membership of the Royal College of General Practitioners (MRCGP) or its equivalent.
It also offers opportunities to subspecialise in areas such as dermatology, obstetrics, and other fields. Registration with a GP is compulsory, ensuring continuity of care for patients.
This has been my chosen specialty for the past 16 years, and I have found it immensely satisfying.