Monday, October 20, 2008

Primary care Physician versus Sub specialist

After my post graduate training in Internal Medicine [ie MD], I had two options. Either to work as a primary/secondary care General Physician or go for a sub- specialisation [or as it is called in India, Super specialisation,ie DM]. I chose the first option. Why? Do I regret it?

Why I chose not to study more? Primary reason was I had become fed up with studies . I had spent almost 26 years of my life studying by then[including KG].
Also I was married and had just become a proud father. Wanted to earn something for myself and my budding family.
Another factor that made my decision easy was the appointment letter from the Government, posting me as a Physician in a small town not very far from my home.

There was also another big reason. I hated confining myself to one organ or organ system. Internal medicine had all the thrills. The wide variety of illnesses that an internist manage made it an exciting profession.
At that time, I had some noble ideals too [young and romantic?]. I wanted to help as many patients as possible especially the poor. So rather than being a super specialist in a 5 star hospital looking after the cream of the society, I preferred the Govt job as an internist in a small, run down Taluk hospital.
Do I regret it?
Yes, some times.
Especially when patients ask, 'Sir enthinde specialista?'[ in what subject are u specialised in?]or when they ask 'do you feel I should see a specialist?'
Some times it is the relatives who ask the same question.
I reply to them trying to make them feel I am an all rounder, knowing about all diseases.
Also, I regret it some times when I realise that the sub specialist's consultation fee is twice or thrice that of mine.
But most of the time I don't regret it. Looking back I feel my decision was right.

I enjoy my profession. I like the thrill of finding out the cause of fever in a FUO [fever of unknown origin]. I like the satisfaction I get when I correctly diagnose the cause of breathlessness in a poor patient by just patiently listening to the history and using the stethoscope,without ordering any fancy investigations. I like the way people come to me for advise regarding anything related to medicine. I am happy taking disease prevention classes to house wives or school kids or teachers or Taxi drivers or 'Positive'[HIV] people. I feel I am doing something when I console and give hope to a crying man or woman when they first realise they are 'Positive'.
So as of now I am happy being a Generalist who 'know a lot about a lot of illnesses rather than a super-specialist who 'know more and more about less and less'.


Seema said...

So rightly said. A typical problem faced by all professionals I guess. Couple of specialisations in my kitty and I still feel clueless. After all its just paper degrees, in the end its experience that counts. A compassionate GP would be a much more relief to the patient than a Specialist who has no time to listen. You are one of those rare breed of GPs I believe. :-)

Charakan said...

Hey you touched a raw nerve there.I am not a General Practitioner[GP]. I had done 3 years MD in Internal Medicine after MBBS. But that is still not a specialisation. I call myself a consultant in Internal Medicine. Most of my patients are referred to me by GPs.Time for listening TO patients..... I am trying my best.Anyway thank you for the comment

Seema said...

eekss! Please pardon my ignorance...

Charakan said...

Ignorance pardoned-; hey it is ok.

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