Life as a general practitionerBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4388 (Published 01 July 2019) Cite this as: BMJ 2019;366:l4388
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Good to read a letter which is about GP! Wish we had a similar set up in our country, probably we could have added more to the research. In India it is a private enterprise mostly individual led (very few group practices) wherein he or she is the all in one.
Running an OPD GP practice is fun and stressful. As the author expressed, a GP deals with all kinds of patients from paediatric to geriatric. And it is mostly disorganised but that is the way it works here. Most of the practices are run out of a small places - because one cannot afford a bigger place and the working hours stretch more than 8 hours daily. Fortunately or unfortunately there is not much paperwork. Few are computerised but the majority still work with follow-up prescriptions and trust their memory! There is always a sense of insecurity both monetary and about violence at the work place. With new guidelines coming, many practices face issues with regulators. Corruption and harassment is the order instead of helping the GP to set one. Though Government and health experts (none of them are from GP backgrounds) agree with the view that the GP is the first point of contact, nothing is being done.
The art of general practice is dying slowly. With the competition from consultants, corporate hospitals, Homeopaths, Ayurvedic, etc., the GP is vanishing. Many young doctors do not want to get into general practice because of long hours of working, no money and quality of life and apathy from society and the Government. Everyone, including doctors' children, wants to get into Information Technology, which promises high paying jobs. I foresee a great impact on society, on costs and on the industrialisation of health. Hope some good sense prevails with the law makers in our country to encourage the GP species.
Competing interests: No competing interests
What a joy! This amazing article, which appears in the portal, the main view of the Journal website (BMJ 2019; 366: l4388, titled "Life as a general practitioner"), has fallen like a ring on to my finger, at a time when, in the Medicine program of Surcolombiana University, we want to make important adjustments to the curriculum, with a strategy of constructing a new one that fits very well with the characteristics of contemporary physician dynamics, as well as satisfying the ethical and moral norms that govern the medical profession in our country.
In Colombia, the true dynamics of the general health care system is regulated by Law 100 from 1993. It is a true great revolution in the history of health services in our country, because it widely allowed extended health coverage to the population. One of its main goals is the creation of a subsidised health care sector for the poorest people. It expanded the possibility for people from all social categories to have full access to qualified medical services. But, unfortunately, corruption; the evil financial culture of paying less and receiving more; and severe social problems related to violence, poor health behavior, and the exponential increase in the incidence and prevalence of chronic and communicable diseases, are the main factors causing the collapse of many public and private health providing institutions. This affects the income and the true professionalism of medical staff to such an extent that it's eroding the true sense of the medical profession.
In a waiting room full of patients with infectious diseases or chronic conditions, or in front of the building facade where physicians attend to patients, tpeople complain about official corruption, health promoting entities, popularly called by their acronym EPS, the hospital, the clinic, or the health dispensary, doctors, nurses, assistants, and in general about everything which is associated with their disease or illness.
The bad implementation of Law 100 in practice, has created a poorly managed health care system, where patients became clients, and executives only think of all that is economically profitable for the EPS. They don’t want to know how to solve the very serious problems of health in Colombia; for them, it is not important to improve the conditions for the provision of a better medical service to patients. In short, they don’t want to lose a single penny of the billionaire economic benefits that the EPS malfunctioning can offer. Those EPS take advantage of medical philosophy and ethics to exploit and pressure physicians to put into practice procedures that are economically profitable for the institution, almost always directed by economists or other professional accountants.
Physicians in Colombia unfortunately are subjected to often humiliating conditions established by the EPS, and for that reason, in many cases, they don’t use the true logic of medical science to diagnose and treat diseases, and so, every day there are several failures produced by the implementation of the medical act determined by the financial dynamics of the EPS. As a result, people always think that the physician is directly to blame; and so, many of them are threatened, extorted, assaulted, beaten, or subjected to attacks and sometimes even killed. The aggrandisement of those standardized procedures by the EPS is leading the medical profession to public dishonor, to the fining of physicians, to the deprivation of medical freedom, and to medical suspensions.
Unlike what is presented in The BMJ article, general practitioners in Colombia are burdened with fear, frustration, anger and impotence. The worst is a fear of being found guilty, with serious consequences, for procedures and complications that can occur in the patients they daily care for.
Competing interests: No competing interests