Irrational use of medical technology

DR. DENNIS J. Aloysius the well known family physician, who is also a past president of the Sri Lanka Medical Association a visiting lecturer of the PGIM, and a member of the HealthWatch Medical Advisory Panel who delivered the Dr. E. M. Wijerama Endowment Lecture for 2005 at the SLMA Foundation sessions held at the SLMA auditorium in Colombo last week.

Speaking on the changes that have taken place in the country's medical scenario in the past 50 years said that while some of them could be labelled as progressive while others as deleterious and added.

"Those days a bedside diagnosis was made by taking a good history, eliciting physical signs and with limited investigations.

"But now we have moved on to increasing irrational use of technology such as echocardiograms, CT and MRI scans. Several private hospitals that provide these expensive investigations and sophisticated therapy have been established.

Problem in clinical medicine

The problem in clinical medicine has not been so much the advent of new technology, most of which has given us greater diagnostic power, but that several doctors are using the new technology as a substitute for clinical assessment based on

* A sound history,

* physical examination

* and a few investigative tests.

I must emphasize that the above is all that is necessary to obtain a clinical perspective.

These infrequently lead to more sophisticated tests.

The above process makes ordering of tests more rational and less wasteful of expensive resources.

We have forgotten compassion and care

Today medicine focuses on investigations and interventions, drugs and surgery, microbes and molecules, germs and genes. We have forgotten compassion and care which not only affects the quality of our lives but our survival as well.

We must accept that there is no cure for certain things William Shakespeare too realized this for he has said.

"There is no time for a man to recover his hair that grows bald by nature."

The consultation:

The consultation is central to the practice of medicine, and is the bedrock of curative as well as preventive medicine. It is sacred but I ask you, has it not become a mockery in the past half century in Sri Lanka?

Sir James Spence has described consultation thus

"The real work of a doctor is not an affair of the health centres or public clinics or operating theatres or laboratories or hospital beds.

Techniques have their place in medicine but they are not medicine.

The essential unit of medical practice is the occasion when in the intimacy of the consultation room or a sick room, a person who is ill or believes himself to be ill, seeks the advice of a doctor whom he trusts. This is a consultation and all else in the practice of medicine derives from it."

In a proper consultation

In a proper consultation the doctor should talk to patients and more importantly listen to them. The patients often complain that the doctor is in a hurry and this is often true.

In the Out Patients Departments where there is often a shocking 2-minute consultation. It also happens in some private practice consultations where some medical professionals deal with 20 to 30 patients in an hour.

Even worse some of them even conduct two to three simultaneous consultations in the same room.

Complaints made against doctors about consultations include

* Doctors do not talk to their patients or even listen to them

* Doctors seem uncomfortable, uneasy and even irritable when patients ask questions about the nature of the disease, the prognosis, the rationale for certain items of treatment

* Doctors appear to be reluctant to obtain a second opinion or to refer their patients.

* Doctors keep patients waiting long hours and show lack of concern for other peoples' time

* Doctors do not keep appointments

* Doctors consultation fees are high and unaffordable

* Doctors prescribe expensive medicines.

Doctors appear to forget that the word 'patient' is from Latin 'Patior' which means, 'I am suffering' and that the word 'patient' has several meanings such as long suffering, forbearing enduring evil with composure, possessing patience.

Doctors must recognise

Doctors must recognize that it is their patients who grant the medical privileges we continue to enjoy.

No matter how difficult it is, doctors should manage their time effectively. At the consultation, the doctor should be a compassionate communicator.

Now let us view that other side of the coin.

Complaints by doctors against patients are many and these include:

* Patients do not have a regular doctor, and they indulge in doctor shopping

* Patients do not comply with any reasonable referral procedure

* The patient consults one doctor and obtains a prescription and requests investigations. After that with or without complying consults another doctor. This creates ethical problems such as: Should the second doctor treat the patient? Should he ask the patient to comply with the first doctor's advice even if he does not agree with it?

If a surgeon performs surgery and there are complications and the patient without referral seeks treatment from another surgeon. What is expected from the second surgeon?

The patients' actions described above sometimes even result in serious misunderstandings and acrimony among the doctors.

But think for awhile, perhaps patients would not be pushed to behave in this unacceptable way had good rapport been established between them and the doctor in the first instance.

Do you have diabetes?
 

BY THILLAINATHAN Sathaananthan, Department of Chemistry, Eastern University, Sri Lanka

SRI LANKA'S population is approximately 20 million, which is growing rapidly and increasing in urbanisation. This tendency is associated with an increase in non-communicable diseases such as Diabetes Mellitus.

The latest figures indicate a double-digit prevalence in the urban sector of approximately 12 per cent with a rural sector at around 7 per cent.

The more dangerous trend is an increasing prevalence of obesity, which is around 35 per cent in the urban sector and a decrease in the age of onset to under 30 years of age. There is a significant lack of awareness of the population with only 50 per cent being aware of their diabetic condition.

This poses a great need to increase the awareness of the condition in the general population. As a developing country in Asia the prevalence in Sri Lanka is similar to that of India and Pakistan and is part of the epidemic.

We seem to have doubled our prevalence in the past decade, which is an ominous sign. This entire trend is of the Type 2 variety and Type 1 remains around 1 per cent of the population.

Diabetes Mellitus (DM) is a disorder where the body is unable to regulate blood sugar levels.

The good news about diabetes is that treatments are very effective and the more you know about your condition, the more you can do to help yourself stay healthy; lead the sort of life you want to live, and to avoid the health problems associated with diabetes in later life.

Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly.

Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapatis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.

Insulin is vital for life. It is a hormone produced by the pancreas, that helps the glucose to enter the cells where it is used as fuel by the body.

The main symptoms of untreated diabetes are increased thirst, going to the loo all the time - especially at night, extreme tiredness, weight loss, genital itching or regular episodes of thrush, and blurred vision.

There are two main types of diabetes. These are:

* Type 1 diabetes.

* Type 2 diabetes.

Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40.

It is treated by insulin injections and diet and regular exercise is recommended.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people often appears after the age of 25.

However, recently, more children are being diagnosed with the condition, some as young as seven. Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. Tablets and/or insulin may also be required to achieve normal blood glucose levels.

The main aim of treatment of both types of diabetes is to achieve blood glucose, blood pressure and cholesterol levels as near to normal as possible.

This, together with a healthy lifestyle, will help to improve well-being and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.

Diabetes is a common health condition. Most of the people in Sri Lanka are known to have diabetes. Over three-quarters of people with diabetes have Type 2 diabetes.

Although the condition can occur at any age, it is rare in infants and becomes more common as people get older.

Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. Nobody knows for sure why these cells have been damaged but the most likely cause is an abnormal reaction of the body to the cells.

This may be triggered by a viral or other infection. This type of diabetes generally affects younger people. Both sexes are affected equally.

Type 2 develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people it often appears after the age of 25.

However, recently, more children are being diagnosed with the condition, some as young as seven. Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. Tablets and/or insulin may also be required to achieve normal blood glucose levels.

All diabetes should be taken seriously and treated properly.

There are some other causes of diabetes, including certain diseases of the pancreas, but they are all very rare. Sometimes an accident or an illness may reveal diabetes if it is already there, but they do not cause it.

Main symptoms

The main symptoms of diabetes are:

* increased thirst

* going to the loo all the time - especially at night

* extreme tiredness

* weight loss

* genital itching or regular episodes of thrush

* blurred vision.

Type 2 diabetes develops slowly and the symptoms are usually less severe. Some people may not notice any symptoms at all and their diabetes is only picked up in a routine medical check up. Some people may put the symptoms down to 'getting older' or 'overwork'.

Type 1 diabetes develops much more quickly, usually over a few weeks, and symptoms are normally very obvious.

In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.

Although diabetes cannot be cured, it can be treated very successfully. Knowing why people with diabetes develop high blood glucose levels will help you to understand how some of the treatments work.

Blood glucose levels

When sugar and starchy foods have been digested, they turn into glucose. If somebody has diabetes, the glucose in their body is not turned into energy, either because there is not enough insulin in their body, or because the insulin that the body produces is not working properly.

This causes the liver to make more glucose than usual but the body still cannot turn the glucose into energy.

The body then breaks down its stores of fat and protein to try to release more glucose but still this glucose cannot be turned into energy.

This is why people with untreated diabetes often feel tired and loses weight. The unused glucose passes into the urine, which is why people with untreated diabetes pass large amounts of urine and are extremely thirsty.

Type 1 diabetes is treated by injections of insulin and a healthy diet. Type 2 diabetes is treated by a healthy diet or by a combination of a healthy diet and tablets. Sometimes people with Type 2 diabetes also have insulin injections, although they are not totally 'dependent' on the insulin.

Indian Hospital seeks collaboration with Sri Lanka on a stem cell research project

A private hospital in India reputed for organ transplant using stem cell technology is seeking collaboration with a private hospital here to work on a research project in this field which is the latest in organ transplantation in the medical field.

This was disclosed to the HealthWatch by Dr. P. Ravichandran MD, DM (Nephrology) Chief Consultant and Head of the Nephrology and Transplantation Department of St. Thosmas Hospital India in an interview with the writer in Colombo on Saturday.

Dr. Ravichandran said the advantage of using stem cell technology in organ transplantation was that it promotes the cell growth in the body where the organ was transplanted thus almost minimising to nil the body's rejection of the transplanted organ.

This meant that the patient could do away with all anti-rejection medications and lead a normal healthy life.

Dr. Ravichandran attributed the rapid increase of chronic diseases relating to the kidney and heart and diabetes due to life changes that we have been adopting like going in for fast foods, lack of exercise and air pollution.

All these are man-made causes and the blame has to go to no one but ourselves, for being blind to reality in our day-to-day living.

Dr. Ravichandran said that a fair number of Sri Lankan kidney patients had got the stem celled kidney transplant done by him in India and they were doing well. In fact his visit to Sri Lanka was to see some of them.

He commended the HealthWatch for presenting articles on medical issues in an interesting way for the readers.

He said he himself was reading the page in the internet whenever he finds the time to do so. He liked the introduction of the Medical Crossword, a novel thing in the page. He was certain this would prove a good avenue to health, educate the public with a prize incentive.

Readers who may have any questions to ask from Dr. Ravichandran could do so by e-mailing the question to him [email protected] and he will reply through this page.

In case you decide to e-mail him please send a copy of your question to HealthWatch, C/o Features Editor, Daily News, Lake House, Colombo 10.

- Edward Arambewela

Cancer news from John Hopkins

1. No plastic containers in Microwave Ovens.

2. No plastic water bottles in refrigerator or freezer.

3.No plastic wrap in microwave.

John Hopkins has recently sent out this information in its News Letters. This information is being circulated at Walter Reed Army Medical Center.

Dioxin chemicals cause cancer, especially breast cancer.

Dioxins are highly poisonous to the cells of our bodies.

Don't freeze your plastic bottles with water in them, as this releases dioxins from the plastic.

Recently, Dr. Edward Fujimoto, Wellness Program Manager at Castle Hospital, was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us.

He said that we should not be heating our food in the microwave using plastic containers. This applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body.

Instead, he recommends using glass, Corning Ware or ceramic containers for heating food. You get the same results, only without the dioxin.

So such things as TV dinners, instant ramen and soups, etc., should be removed from the container and heated in something else. Paper isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc.

He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons.

Also, he pointed out that Saran wrap is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat caused poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.

- Sent by Joe Aloysius