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Doctors are in short supply

Of course, it’s all the fault of “Dr. Kildare”. Had the original radio series not been such a success, it would never have been transferred to the TV screen, making Richard Chamberlain a star. This is not to say that physicians had escaped glamorisation before. There were movies showing surgeons as gods. But “Dr. Kildare” was the first prime-time series with a young hero leading an experienced cast in a hospital melodrama. As a result, society was finally convinced that becoming a hospital doctor was the coolest thing on the planet. This completed the cultural task of giving the medical profession top status, eclipsing the work of Raymond Burr in “Perry Mason” who had done so much to make the defense attorney seem the most desirable job. So the boomers grew up with the fixed idea that becoming a doctor and saving lives in a hospital setting was “the” career path to follow. One of the first victims of this transference was the role of primary care physician working in their offices or local clinics. Although a socially necessary position, it lacked charisma and, from the 1960s onward, it grew challenging to persuade newly qualified doctors to work more anonymously. Only those with a social conscience followed this path, taking less money and working longer hours than those who stayed in secondary and tertiary care. That’s why, today, the vast majority of primary physicians are old and coming up to retirement.

Primary healthcare has become a grind with doctors seeing an endless supply of patients for just a few minutes at a time. Gone are the days when a caring old guy would know every last detail of the generations he had brought into the world. The modern doctor has seconds to decide what is wrong with the patient and which prescription to write before calling in the next piece of meat. That makes it almost impossible for the average patient to go through a full diagnostic examination unless money is available to pay for a referral. It is equally impossible for the front-line doctor to tell the difference between a genuine patient and a drug addict looking for the next bottle of pills. That is one of the reasons why the level of prescription drug abuse is so high in the US. It is ironic that people who find life unbearable should seek the help of primary caregivers whose lives are equally unbearable.

In this situation, the patient becomes the victim of the pharmaceutical industry. We are brainwashed to accept medication as the best form of treatment. In this, the most powerful painkillers are among the most abused. They are, after all, the most addictive. In this one sense, tramadol stands out. It is the most prescribed drug for the relief of moderate to severe pain and, over the years, it has built up an unbeatable record for safety and effectiveness. But it is not addictive in the same sense as the opiates. It is still possible to become psychologically dependent on tramadol but it is less dangerous than the more powerful opiates. Sadly, there is no active discussion on how to persuade more doctors into the primary healthcare role. Without this, patients will not be encouraged into the better forms of pain management. The medical profession will continue to recommend painkillers as the most effective treatment.