The Family Physician: A Dying Romantic Idea

I have been known to lament the loss of the prestige of the basic medical degree (MBBS) in India. While you may or may not agree with it, the truth remains that nobody who is doing (or has recently done) an MBBS course wants to stay out at that level. Everyone wants to go and be a specialist or super-specialist. In the melee of confusion arising therefrom, we are slowly pushing the generalist, family physician to an early extinction.

Even William Osler, the Father of Modern Clinical Medicine, was enamored by the concept of the omnipresent (and often omniscient) general practitioner. Osler once said:

“It cannot be too often or too forcibly brought home to us that the hope of the profession is with the men who do its daily work in general practice.”

That is the reason, why, every time I come across a feel good story about a family physician working out from the rural hinterlands, helping people without regard for money or fame, I feel a small twinge at the depths of my heart. I am sure we all do feel that pull some time or the other. However, society and economics have warped us into calculative beings that always try to balance both sides of the ledger and then leave a lot on the savings column. There is no denying that life is like that and turning away from it is being in denial, but, sometimes, I wonder if it would do the skewed, curative-obsessed, over-medicalized culture today some good to have them re-oriented to the primary care model.

That is part of the reason why I read the news article about Dr. Russell Dohner from Rushville, Illinois with considerable interest. The other bit that really drew me to the piece was the fee he charged from his patients: 5$!

This is a bit of an old article from Yahoo! News, and I am linking to it so that you can check out the whole story for yourself, and without having me to spew the same stuff over again.

dr russell dohner

Image Credits: Associated Press/Jeff Roberson (from Yahoo! article)

I understand that having an alternate, steady income, (he admits that his livelihood is maintained by the money the farm brings in) and not embracing the expensive modern gadgetry (computers, fax, EMRs) has kept his practice alive. He also does not take any medical insurance and often waives the fees for patients when they are in a spot of bother. He is, in every manner, the quintessential country family doctor, who, the article reckons, has delivered the whole town. I also recognize the fact that his advanced age (he was 87 years old at the time of the publication of the Yahoo! article) would be a deterrent for practice in most institutions. Asking anyone to even emulate his actions would be an act of insanity in an age where medical care is rapidly becoming the most expensive commodity up for grabs.

However, these issues aside, he has chosen to forego the fees that his seven-decade spanning experience deserves. He charges a nominal fragment of what he could have easily asked for. The farm-is-there logic is strong, but it also shows that he did not run after the lucre. Despite everything, it even softens the cynic’s heart.

However, when you are 28 years old, sometimes with a family to take care of, and with an inhuman load of $300,000 or more in student debts on your shoulder, the last thing that you want to do is to repair to rural Illinois and serve as a Family Physician looking at patients for a farthing (and sometimes, not even that!). Dr. Dohner, I am afraid, may be the last one of a dying breed. With his demise, the chapter on the altruistic, ever-on-call-at-hand, ready to help Family Physician may go out of vogue. Now your FP may be a person in a conglomerated private practice who works on the same principle that any corporate body functions with – making profits. And you cannot blame him for that!

We may not have fields or farms to fiscally support our eccentric medical desires; we may not have our medical educations sponsored by the government, and hence, being debt-free, turn our lives in for society; we may have the very-understandable foibles of wanting to live a good life; but I am also very sure, there is that one neglected corner in our hearts that we are in denial about, where we want to be the Dr, Dohner, for whom people from four or five counties can vouch for.

Not unlike this old country doctor, who caught the poet’s fancy with his frugal life and limited desires:

Old Doc Brown

He was just an old country doctor
In a little Kentucky town
Fame and fortune had passed him by
But we never saw him frown

As day by day in his kindly way
He served us one and all
Many a patient forgot to pay
Altho’ Doc’s fees were small;

But Old Doc Brown didn’t seem to mind
He didn’t even send out bills
His only ambition was to find
Sure cures for aches and ills

Why nearly half the folks in my home town
Yes, I’m one of them too
Were ushered in by Old Doc Brown
When we made our first debut;

Tho’ he needed his dimes and there were times
That he’d receive a fee
He’d pass it on to some poor soul
That needed it worse than he

But when the depression hit our town
And drained each meager purse
The scanty income of Old Doc Brown
Just went from bad to worse;

He had to sell all of his furniture
Why, he couldn’t even pay his office rent
So to a dusty room over a livery stable
Doc Brown and his satchel went

On the hitching post at the curb below
To advertise his wares
He nailed a little sign that read
‘Doc Brown has moved upstairs’;

There he kept on helpin’ folks get well
And his heart was just pure gold
But anyone with eyes could see
That Doc was gettin’ old

And then one day he didn’t even answer
When they knocked upon his door
Old Doc Brown was a-lyin’ down
But his soul – was no more;

They found him there in an old black suit
And on his face was a smile of content
But all the money they could find on him
Was a quarter and a copper cent

So they opened up his ledger
And what they saw gave their hearts a pull
Beside each debtor’s name
Old Doc had writ these words, ‘Paid in full’;

It looked like the potter’s field for Doc
That caused us some alarm
Til someone ‘membered the family graveyard
Out on the Simmons farm

Old doc had brought six of their children
And Simmons was a grateful cuss
He said “Doc’s been like one of the family
So, you can let him sleep with us;”

Old Doc should have had a funeral
Fine enough for a king
It’s a ghastly joke that our town was broke
And no one could give a thing

‘Cept Jones, the undertaker
He did mighty well
Donatin’ an old iron casket
That he’d never been able to sell;

And the funeral procession, it wasn’t much
For grace and pomp and style
But those wagonloads of mourners
They stretched out for more than a mile

And we breathed a prayer as we layed him there
To rest beneath the sod
This man who’d earned the right
To be on speaking terms with God;

His grave was covered with flowers
But not from the floral shops
Just roses and things from folks’ garden
And one or two dandelion tops

For the depression had hit our little town hard
And each man carried a load
So some just picked the wildflowers
As they passed along the road;

We wanted to give him a monument
Kinda figured we owed him one
‘Cause he’d made our town a better place
For all the good he’d done

But monuments cost money
So, we did the best we could
And on his grave we gently placed
A monument – of wood;

We pulled up that old hitchin’ post
Where Doc had nailed his sign
And we painted it white and to all of us
It certainly did look fine

Now the rains and snow has washed away
Our white trimmings of paint
And there ain’t nothin’ left but Doc’s own sign
And that is gettin’ faint;

Still, when southern breezes and flickering stars
Carress our sleeping town
And the pale moon shines through Kentucky pines
On the grave of Old Doc Brown

You can still see that old hitchin’ post
As if an answer to our prayers
Mutely telling the whole wide world
‘Doc Brown has moved upstairs’.

Regular program of bitter, cynical writings shall commence soon. Don’t lose hope, ye ones of little faith.

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14 thoughts on “The Family Physician: A Dying Romantic Idea

  1. Dr Dohner and Dr Brown were amazing people. They chose to be what they were and they chose to charge minimally or nothing for many.
    But, why should this be restricted to healthcare alone? If this principle is to be replicated, everyone should offer everything free. Maybe we should go back to the barter system in ancient history :). Kidding apart, in an ideal world if each of us takes what we need and not what we want out of greed, there is enough in the world to go around. But once again… hats off to these two docs and the many others who still exist in the world. Silently – not showing off their goodness!

  2. Wonderful blog Pranab!

    If you haven’t already, You may like to read about the wonderful work by Dr. Abhay and Rani Bang (Shodhgram), Dr. V. Shanta ( Adyar Cancer Institute), Dr. V- Aravind Eye Care system, Dr. George (THI).These are some of the physicians from India who have defied odds and worked relentlessly for the poor.

    Keep up the good work!

    • Thanks so much Dr. Bajaj. Yes, I am aware of the exemplary work being done by Dr. Abhay and Rani Bang. I also have immense respect for what i being done by a group of selfless doctors over at Ganiari (Jan Swasthya Sahyog, I think, is the full name). I think I read about Dr. Aravinda Eye Care system. Is it the one where there is a community-supported medical insurance sort of thing? I shall try to catch up on the other physicians that you have mentioned.
      And thanks for dropping by and leaving the encouraging remarks…

  3. PC – Aravind Eye Care system has a unique model of allowing anyone to avail of either free or paid services. Our former president Abdul Kalam, did not have enough cash to pay and offered to pay by chq, which they could not accept. He asked if he could avail of the free treatment and they said “of course”! I have a book about the entire evolution of the Aravind Hospitals – fascinating reading! And very inspiring

  4. SO, I am a GP, working with a company that’s bringing back the family doctor. You could check out NationWide Primary healthcare.
    Ethical, evidenced based and not giving a hoot about how the rest of the industry does it. we also spend 3 hours every week, in a structured learning program

    not dead, not by far

    • You seem to be an exception to the rule. But yes, I’ve mentioned that conglomerated GP may work. The romance of being a 5$ doctor is dead. Also, most budding physicians do not want to go into Family Medicine per se. The fascination lies with the super specialties.

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