One often wonders how the South African public, and perhaps more particularly the members of medical schemes, view our country’s general practitioners (GPs).
What do they believe their function and value to be? What important functions do they perform that contribute to the overall healthcare delivery in our country? What reasons would patients perhaps have for believing that 10 and more years of study and experience would not make their GP capable of caring efficiently and effectively for many of their healthcare needs and, where appropriate, referring them for specialist opinion and/or treatment.
There is no doubt that South African qualified medical practitioners receive some of the best medical training available and are generally highly regarded anywhere in the world. In addition to their superior academic training, South African doctors are faced with what has been described as a ‘quadruple burden of disease’ which includes a wide range of communicable (infectious) diseases, a rapidly growing incidence of chronic diseases of lifestyle, a high incidence of trauma and a wide range of maternal and peri-natal conditions associated with pregnancy and confinement.
This all provides our GPs with a vast amount of training and experience which in turn equips them more than adequately to deal with such things on a regular basis.
So when people fall ill and require the services of a doctor in the private sector, where do South Africans turn and what determines that choice?
Sadly, the tendency is more and more towards members self-referring directly to a specialist.
We are, of course, extremely fortunate in our country to have superbly trained specialists across the entire spectrum of specialist disciplines and they are obviously experts in their particular field of practice, whereas the GP is required to have an overall but perhaps less detailed knowledge across all disciplines of medicine.
In choosing where to seek care, the real question should surely be related to the level of expertise required for the care that is sought. In other words, specialists should be seen as delivering a service to patients only when requested to do so by a GP, who has decided, together with the patient, that a greater expertise than s/he has, is required for the management and treatment of a specific illness or condition.
So why is it that patients in our country will often choose not to consult with their trusted GP for things that are often as routine as monitoring of their blood pressure or diabetes or asthma? Why are the services of a gynaecologist sought for routine issues such as contraception or annual check-ups? Why do children need to see a paediatrician for routine illnesses and conditions?
The ‘old-fashioned’ approach of building a sound relationship with a general practitioner has enormous benefits, the most important being the critically important coordination of one’s overall healthcare. This has the effect of not only building trust, but also of impacting on the future affordability of healthcare which is under severe threat, not only in South Africa, but internationally.
There is a suggestion that any service capable of being delivered by a GP, but where the services of a specialist are used, ends up costing approximately 30% more. This should not be seen as suggesting that specialists are in any way over-charging for their services, but is merely mentioned in the context of highlighting the need to carefully spend every health rand wisely so that we are able to better manage the current levels of medical inflation that have out-stripped CPI by an average of 3% per annum for the last 10 – 15 years. This would, in turn, have a positive influence on annual increases in medical scheme contribution rates and make the funding of healthcare more affordable.
In summary, there are many reasons why this scenario of self-referral has evolved, but perhaps the time has come for South African GPs to re-claim their rightful role in the system and for patients to be encouraged to first seek medical attention at an appropriate level of care.
Article written by Dr Sid Mobbs, Clinical Head, Genesis Medical Scheme