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Healthcare around the world has changed dramatically over the years. While it has improved in detection of diseases through latest state of the art machines it has become impersonal and the centuries old relationship between patient and doctor and indeed entire families has gradually eroded. Patients are now only recognized through their medical records and hardly if any personal exchanges take place during a visit to the doctor.
Gone are the days that doctors knew each patient by name and not only his family members by name but also the ailments if any of each one.
A visit to the doctor would in the old days entail an overview of the health of the entire family with the doctor remembering precisely what medicines each family member was taking and what improvements had occurred since the last visit. In Pakistan the story is not too different.
In the early days after Partition there were no fancy hospitals with the luxuries that can be associated with 5-star hotels. The Karachi hospital scene was dominated by hospitals mostly run by Christian missionaries like the Seventh Day Adventist Hospital and the Holy Family Hospital and government hospitals like Civil and Jinnah.
Most of the patients were served by government run dispensaries. Yes, it sounds inadequate, but they were really well run and the doctor and his trusted lieutenant the compounder worked hard and with dedication.
Prescribed medicines were few in those days and most of the patients got their medicine from compounders who according to the doctor’s instructions mixed up certain ingredients in bottles that were brought by patients for that very purpose.
If required, the compounder would stick clearly marked labels on these bottles, indicating each dose to be consumed. I remember my mother carefully keeping these bottles after they had served their purpose for the next visit to the dispensary.
This also indicates the general trend in those days when nothing was wasted and any and everything that could be utilized again was preserved and not thrown away. It saved the community from an invasion of trash and helped households economize on their spending.
Our doctor in what was in those days Jacob Lines was the tall energetic Dr Anwar Ahmad Khan, a hockey player from Badayun (UP) before Partition. He ran the government dispensary and was on first name terms with most of the patients. The important thing was that he made house visits in the evening if required.
House visits by the doctor is a luxury that is not available cheaply or easily nowadays but in those days it was common practice. Come evening we would be waiting impatiently when the doctor’s booming voice will announce his arrival and he would be asking which household member was not feeling well. He had this leather bag commonly known as the Gladstone bag which he would place on the floor and put his fingers on your pulse.
It is amazing how in those days the doctors could detect your illness without the help of expensive laboratory tests. Just a finger on your pulse was enough in most of the cases. In case the patient was a purdah-observing female the doctor would sit behind a curtain and the patient would extend her hand from behind the curtain and again the doctor’s hand on the pulse would tell the story of the ailment.
As far as house calls in the western world in the early 90s are concerned they also became necessary as sometimes the patient was too sick to travel on horseback to the doctor’s clinic. In those days there were no ambulances no 911 and Triple-0, and it was before the days of 999.
House calls would make up 40 percent of U.S. doctors’ visits in the 1940s, before going into decline in the 1960s. These days, they comprise less than one percent of consultations. As far as doctors making home visits, that is a thing of the past.
Doctors are entirely too busy to make house calls except for the very rich and famous. This service is called concierge home doctor. The word concierge means “keeper of candles”. The role of candle keepers in medieval noble castles was to always be “at hand” to the inhabitants and visitors of the castle.
The concept of concierge home doctor visits provides private, personalized medical service of the highest level in the comfort of your home.
It is the digital age which has once again brought the patient and the doctor together in Pakistan. There are various Apps that replicate house calls by patients able to call doctors at any time of the day or night and consult their ailments.
Those who have already subscribed to the App have their medical histories available to the doctor on call. After listening to the present problem, the doctor can access the medical history of the patient and advice if he or she needs to go to a hospital or prescribe some medicine for temporary relief. For people in far flung areas this is a valuable service, and most Apps are very economical.
It has been a long journey from the days of the friendly neighborhood doctor to the gleaming well-equipped hospitals of today. Patients and diseases have multiplied manifold. Sometimes I remember the warmth and concern of doctors of yester years and their ability to diagnose diseases with just a hand on my pulse.
Copyright Business Recorder, 2022
Zia Ul Islam Zuberi
The writer is a well-known columnist and Head of Corporate Communication at Nutshell Communications