Health system that allows patients to send themselves to costly specialists needs to end, top medics say

Clinics urge patients to see GPs regularly to catch cancers and curb waste

Abu Dhabi, United Arab Emirates - February 20th, 2018: Dr Rakesh Suri, CEO, Cleveland Clinic Abu Dhabi. Press conference to celebrate the clinical milestone of the UAE's first transplants from deceased donors for all four major organs "The Gift Of Life - Major Organ Transplants in The UAE". Tuesday, February 20th, 2018. Cleveland Clinic, Abu Dhabi. Chris Whiteoak / The National
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Family doctors need to be put at the heart of the UAE's healthcare system to catch illness earlier and build a culture of check-ups and healthy lifestyles.

That's the message from the heads of the country's major hospitals as they cautioned against the long-time approach of specialists being at the frontline of healthcare.

For too long clinics and hospitals have allowed patients with sore ankles to see consultant orthopaedic surgeons and those with aches and pains to top specialists, senior medics said.

"I've had patients asking me for all sort of things from abdominal pain, from headaches to eye pains,” said Dr Rakesh Suri, chief executive of Cleveland Clinic Abu Dhabi and one of the world's foremost heart surgeons, specialising in robotic surgery.

He said current habits become most evident after an operation, when patients are asked who their family doctor is, in order to share records and ensure they receive regular check-ups.

“They respond, 'but you are my doctor' and while it is heart-warming … I still know that that this is not the best way to have them followed up.

"The expertise and availability of a general practitioner and a family doctor is what will keep that patient healthy for years, so I am as equally motivated to develop the network of referral."

Mubadala Healthcare, which Cleveland Clinic is managed by, is currently working on a referral system which involves having family doctors on the frontlines and sending patients with complex needs to specialists if needed.

And last year, Health Authority Abu Dhabi, now called the Department of Health, said it would clampdown on patients referring themselves to costly specialists, or 'doctor shopping', to bring down insurance costs.


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The shift is not just focused on controlling costs, but also ensuring patients get regular check-ups, which is crucial to the early diagnosis of cancer, heart disease and diabetes, which the UAE has high rates of.

“In an integrated health network, you see patients routinely when they are well — they routinely get yearly health care check-up, they get the screenings when they need it and if we detect disease earlier, we prevent disease more effectively."

The intention is to "allow people to live happier, healthier and longer lives,” Dr Suri said.

Stephen Maclaren, a senior executive at Dubai insurer Al Futtaim Willis, said it is not uncommon to see patients go for "second, third and fourth opinions from specialists".

"If people are going from consultant to consultant without seeing a GP first, that is time consuming and expensive," he said in an article with The National last year.

Healthpoint in Zayed Sports City already employs a GP and family doctor system. It then refers patients up the chain, including to its own three centres of speciality — sports injuries, spine and orthopaedic surgery — or to other hospitals.

"The combination between primary health and specialised health is welcomed by patients," said Dr Mai Al Jaber, acting medical director and a public health specialist.

"They come to outpatient clinics for primary healthcare services and then are referred to the specialised centres either here or Cleveland Clinic."

Dr Al Jaber acknowledged the scale of the challenge, which is regarded as the product of an insurance-based private healthcare system that allows patients to choose their own treatment.

“In the UAE, the concept of primary healthcare didn’t exist until recently," she said.

"Now the community is gradually getting more oriented on the importance of primary health care and of having a family physician who can solve the majority of their issues."

Despite growing awareness about lifestyle diseases and the prevalence of cancer today, very few people go to the doctor unless something is wrong.

A Cancer Research UK study from 2014 found 46 per cent of cancer patients were diagnosed at a late stage. For lung cancer just 23 per cent were diagnosed at stage one or two.

"For a long time we have talked about the need for mammograms and the importance of breast screenings, but still we see cases diagnosed at the later stages," she said.

"We are constantly running campaigns but we still see cases who presenting late.

“Our culture of awareness should start from the school and focus on the importance of a healthy lifestyle, the importance of screenings and the importance of preventive screenings."

About 80 per cent of Healthpoint's patients are Emiratis, many with diabetes and high blood pressure.

It is urging this group of patients in particular to have regular check-ups with a family doctor, but it remains a “challenge,” officials said.

Another benefit is the traditional role of GPs and family doctors giving patients a reminder about their diet and weight, not something they may hear from others.

Dr Kawthar Al Ameri, a family medicine specialist at Seha’s Al Rowda Healthcare Centre, said there is a need to replicate the system seen in the UK and Canada.

"The role of a family physician is clearly identified and well practised by patients and healthcare providers, which reflects the family medicine scope of services. Whereas in the UAE there is a lack of awareness [of the need for regular check-ups].

However, Dr Al Ameri did say the number of Emirati family doctors is increasing, which may help more conservative families open up about complaints and ailments.

"This will hopefully overcome the obstacles that healthcare facilities are facing," he said.

Despite being used interchangeably, experts point out that there is a distinction between GPs and family doctors, the latter being a speciality that would look into the family history of a patient, particularly important in a country where genetic diseases, particularly in Emiratis, are common.