Reinvigorating comprehensive primary healthcare is the way to resolve declining doctor-patient relationship

Sir, In his insightful editorial Raman Kumar addresses some burning issues of the medical profession and the doctor-patient relationship of present-day India.[1] He states that the primary duty to protect the right to live with human dignity is the fundamental right of each citizen, both doctor/patients alike, and it is given under article 21 of the Indian constitution. In the sharp deterioration of doctor-patient relationship, he traces multiple reasons to this issues, namely: this is not just a police and security issue but a complete failure of public health system, the momentum and trajectory being in the favor of several hospitals and medical colleges, unwillingness to bolster comprehensive primary healthcare (CPHC). Comprehensive primary care should be reinvigorated through investment in a permanent, strong and general health system instead of 36 vertical programs. In my observations, the value of social justice with equity and social determinants of health are the factors which can make CPHC viable and meaningful. Nearly 80–90% of people's health requirements throughout their lifetime can be provided within a primary healthcare framework—from maternity care and disease prevention through vaccination, to management of chronic conditions, and palliative care. As population's age, and multi-morbidity becomes the norm, the role of primary healthcare workers becomes even more important. Therefore, we must consider investing in primary healthcare through four delivery platforms, namely, community-based care, healthcare centres, first-level hospitals, and population-based interventions.[2] Evidence presented at the European Health Forum Gastein, Austria, from October 3rd to 5th, 2018, documented the need for new curricula, multi-professional settings, and organizational support. In WHO's report it was clearly enunciated, “Globalization is putting the social cohesion of many countries under stress, and health systems being key constituents of the architecture of contemporary societies, are clearly not performing well in the manner they could and as they should.”[3] According to American experience, the greater use of primary care has been associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality.[4] Further, Michael Marmot points to the fact that universal health coverage is unlikely to direct much attention towards social determinants of health and “inequities in power, money, and resources that give rise to them.”[5] Moreover, American experience alarms us with the fact that, “We find it terribly and tragically inhumane. tens of thousands of other citizens of this wealthy country will die this year for lack of insurance.”[6] Financial support and sponsorship Nil. Conflict of interest There is no conflict of interest.

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