July 1994, Volume 44, Issue 7


Whither Gps.....

Inayat H. Thaver  ( Baqai Institute of Health Sciences, Karachi. )

GPs - the General Practitioners, is the colloquial name for primary care providers or family physicians. Most of them are in private practice so they are sometimes labelled as private practitioners - PPs. Historically these PPs/GPs have been providing the valuable services, initially as traditional healers, eastern medicine practitioners, homeopaths and since last one century as allopaths. Inspite of the claims by many developing countries including Pakistan for providing free medical services, privatization of medical practice is increasing1-3;  people are also willing to pay for seeking medical care44,5. Even the poors residing in squatter areas are availing medical services, privately6,7. Though, these PPs/GPs are proving valuable services, they have been traditionally blamed for irrational use of drugs8,9, profit- drive motives10,11, emphasis on curative care12 and thus being detrimental to primary health care13, which is nowadays a major strategy for improving health. They have, even been labelled as “jack of all trades” meaning to say they are master of none, But the fact of the matter is that people still prefer their services14. So what do the health policy makers and planners need to do? Should PPs/GPs be totally ignored (as is being done?) and according to the theory of “bad apples15, they be thrown away? Or are there rooms for improvement?! A number of alternatives have been suggested, including continuous medical education and training16 and legislation17,18. Recently a newer approach has been tried in a number of places specially in Australia called as “Academic Detailing” 19. This strategy utilizes the same principles as of pharmaceutical companies for promoting their drugs; thus proper ‘detailing’ can improve rational use of drugs. In addition to that, if properly trained and backup support provided, the Gps/PPs can even become a part of primary healthcare system. Improved and mgular contact with the government hospitals can also improve the referral system by them. A very wise move by College of Physicians and Surgeons Pakistan (CPSP) is to start Diploma (membership) programme for family physicians. This, though needs to be adopted by Pakistan Medical and Dental Council (PMDC) as a compulsory subject (family medicine), at under-graduate level, too.
To summarize, GPs/PPs are the most important and potential primary care providers, who need to be utilized for improving health care. Mere lip services and down-grading them will only aggravate our own health problems. Repre­sentative bodies and policy planners need to develop strategies for involving this private sector.


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