IT is common knowledge that life as a junior doctor in public hospitals is not a bed of roses despite the various improvements that have been put in place over the past few years. One of the most common complaints that can be heard is about the lack of doctors. But it is less common to hear anyone mention there being too many patients at hospitals.

Recently, a friend lamented that her caseload could easily be reduced by half if her patients did not present with chronic diseases that could (and should) have been easily dealt with at a primary care setting. It is not difficult to see how presentations of conditions such as hypertension or diabetes are better managed in the community, thus bringing into question the duty of primary care as well as individual responsibility.

The role of primary care should not be underestimated. It deals with the bread and butter of medicine, and should be at the forefront of co-ordinating services when the patient needs care from other health-care sectors. It is also a place where a holistic approach to public health policy allows such policies to be transformed to practice on the ground.

There is plenty of evidence to suggest that a good relationship with your general practitioner is associated with better and more appropriate care. One can go so far as to suggest that conditions such as heart attacks and strokes are almost completely preventable, if risk factors are managed appropriately in the community.

There has to be a degree of personal responsibility too. The old adage "prevention is better than cure" holds true in most circumstances. We tend to have the unfortunate habit of seeking help or looking after ourselves only when physical manifestations of our illnesses appear, neglecting our bodies at other times while our insides scream for a bit of tender loving care.

Anecdotes are aplenty. I recently came across a diabetic patient who presented me with a gangrenous toe, but who had previously decided not to take any of his blood sugar-lowering medication because he felt well himself.

Unfortunately, primary health-care in Malaysia is provided in a rather erratic manner without sufficient horizontal or vertical co-ordination. Information is not readily transferable between health-care professionals leading to fragmentation and duplication of care, a situation that is worsened by our habits of jumping from one general practitioner to another.

This calls for a streamlining of the current system into one where good communication unites the disparate entities within it. A better flow of information between health-care professionals will help improve situations, as this will allow for a smoother transaction with colleagues at secondary care and earlier acknowledgement of a patient’s medical history. Methods such as electronic medical records and even personal handheld pen drives should be looked into.

It would also be useful for the government to elevate the speciality of family medicine and to encourage medical students and junior doctors to seek attachments in the primary care setting, both for practical and research purposes. There should also be a move to place such professionals in areas that are economically and socially deprived, as it is these places that tend to bear the brunt of chronic disease epidemics.

The general public needs to be educated so that they see primary care as a resource to manage their chronic diseases, and secondary care for more acute emergencies. Simple measures such as proper compliance with medication and leading a healthy lifestyle will go a long way in not only improving one’s well-being, but in helping to ease the strain on our health-care system.

At present, most urbanites tend to visit private general practitioners. The downside to this approach is that due to financial costs, they tend to be hesitant on visiting their family doctors for routine check-ups, and only do so when an emergency arises.

This is where the government might be able to step in and play a role by providing incentives to both the individual and the general practitioner by providing health-care vouchers to the former and financial remuneration to the latter; provided that they both take part in the scheme of placing more emphasis on disease prevention.

There is great scope for improvement for our primary care setting and it is hoped that this sector will get the backing that it needs.

But at the end of the day, the management of any disease or illness boils down to the relationship between the health-care professional and the patient. Both have to play their role to ensure that the partnership is successful.

Dr Helmy Haja Mydin is health-care policy fellow at the Malaysia Think Tank (www.wauBebas.org). Comment: lettters@thesundaily.com