The multiple worlds of an urban (Family) physician.

After spending last 5 years in rural Bihar, coming to Delhi and practicing was a new experience. In one sense a culture shock. In the last three months of practicing General Medicine (more of Family Medicine) I encounter different subsets of patients.

One subset – the upper class.  The educated, google doctor patients, health aware, who get a full battery of tests which includes Hb to Serum Selenium even, every 3 to 6 months, and is on all kinds of replacements for every small dip in the values! For them every simple symptom is an indication for invasive Radiological evaluation and till that is done, they worry. Some of them during covid have had multiple online consultations and has not seen a doctor face to face for 2 years. But they found options of getting their tests done at home and finding windows when they could get their radiology done with special appointments and minimal covid exposure. Most of them have lifestyle related diseases – with DM and CAD and HT as the predominant ones. But many have challenges of mental health issues, precipitated by the pandemic related broader issues and fear of potential ill health.

The challenge of managing such patients is – of the 10 minutes or so one spends with the patient, majority of time goes in sorting through the test reports. Most of which might not have any relevance. Rest of the time is to assure and convince them that they are healthy and their so called mild (for me), but major (for them) symptom is part of normal physiological process of aging, sedentary life etc. and does not need much intervention.

The second subset is the urban middle class, like the above group in terms of their health care access and awareness but have lost their trust in the commercial health care systems. And has been under absolute lock down even now. Slowly out of necessity they are exploring options where they can find doctors whom they can visit. But they are too soon catching up with the above group in terms of the tests they do, six monthly insurance/employer covered executive checkups which includes every possible test, and then starts worrying about the changes in the lab parameters.

Most of them are on Vitamin D and B and multiple supplements and try to be on various diets which change depending on the season. This season is one of Intermittent fasting. They seem to have been the group most affected by covid during the second wave. Many were infected and many are suffering from Post covid syndrome. The young among this group has much “mental health issues”, due to effects of lock down, covid and uncertainties. The elderly in this group has been also challenged much in terms of regular health care. Afraid of visiting hospitals, they have compromised on their management of chronic illnesses. 

The youth need much counselling and support, the elderly need to have complete rebooting of their treatment protocols and a start from scratch!

Then there are the migrant workers and laborers. They come only when they are seriously sick. In the last month, there were a few Scrub typhus, many Dengue, occasional TB, a stray chronic malaria, and a few occupational accidents.  Almost like any rural North India disease profile. But even among this group, there are a few who are coming with panic attacks, fear, all emerging out of an uncertain tomorrow.

These are the easiest to take care. They do not have many expectations, but only to be cured of the current challenge. They take one day at a time and live in the present!

I wonder if the current pandemic is one of mental health. Precpitated by the VUCA context, made complex in some by the executive check ups. I need to retrain myself to be relevant for today. To listen more, to test less and to accompany long term...Is that not the role of a Family Doctor?