Missing the basicin a basic checkup

The Department of Health, headed by Secretary Paulyn Jean B. Rosell-Ubial, launched a few days ago the Duterte Health Agenda. One of the three major goals is to provide mandatory basic checkup to 20 million poorest Filipinos within 100 days.

Our countrymen in the lowest quintile of society should avail of this important benefit which may serve as a screening procedure to detect diseases at an early stage. This has been a perennial problem in our country. We probably take care of our cars or other devices more than we take care of our health. We send our cars for regular oil change and tuneups, but when it comes to our health, we rarely go for checkups if we don’t feel anything.

We only see our family doctor when we have symptoms already, and we’re obviously afflicted with a disease. In many instances, it might be too late because the disease is already in an advanced stage.

Preventive strategy

We’re happy to note that we’re trying to shift from a curative type of healthcare to a preventive strategy—to prevent diseases, or catch them in an early stage so as to prevent complications.

Actually, in fairness to previous administrations, there were already similar efforts in the past, but sometimes, the problem is how to execute the strategy and achieve this goal. We need to convince the public, especially the poor sectors to avail of this benefit regardless of whether they have symptoms or not.

A good example is in the detection of hypertension or high blood pressure. It only takes less than five minutes to check the blood pressure, but only around 50 percent of the hypertensive population of the country are aware that they have high blood pressure. The 50 percent who are not aware never bothered to have their BP checked simply because they don’t have any symptom attributable to hypertension.

Change of mindset

Some are simply foolhardy why they don’t want to have their checkups. They would reason that their doctor would just tell them to quit their smoking, reduce their alcohol intake, and avoid eating fatty foods; and they’re not willing to do that.

So the road to good health really starts with a change of mindset. It sounds simple enough, but it’s actually easier said than done. The DOH really has to exert effort through the local government units to make sure that this mandatory annual checkup is availed of by our poor countrymen.

The public should be made to realize that many of the country’s prevalent diseases like high blood pressure, heart disease, diabetes, lung diseases, and cancer are not associated with any symptom during the early stage; but over time, serious damage to the body organs develop and when one waits until symptoms are present, the organ damage might be too advanced already and treatment may not be of much help.

When we say basic checkup, I hope Secretary Ubial will emphasize to her implementing teams that it does not mean simply taking blood, urine and stool specimens; and doing a chest X-ray.

What is an important and truly cost-effective basic component in a basic checkup is a good medical history-taking and physical examination (PE). We always tell our young doctors that by just a complete history and thorough PE, one can already come up with a reasonable assessment of the patient in 85 percent of cases.

We need the results of our laboratory examinations to validate what we already suspected by history or PE; or in 10 to 12 percent of cases, the labs are necessary to point us in the right direction for the diagnosis. In about 3 to 5 percent of cases, despite a thorough checkup including sophisticated laboratory procedures, the right diagnosis may still be elusive.

‘Clinical eye’

So our DOH teams should not dispense the history-taking and PE in the checkup. Our doctors of old didn’t have any of the laboratory tests we have now, but they apparently did well in treating their patients. Perhaps, as a form of compensation, they developed their so-called “clinical eye” such that they already have a good sense of what’s wrong with their patients the moment they finished talking to them and examining them.

This is what we seem to be gradually losing with modern medicine. The reliance on sophisticated laboratory procedures has increased so much that some don’t even bother to examine their patients, and would just wait for the laboratory results to arrive. When the labs come, one can now search from some downloaded apps what the suggested treatment guidelines are for the identified problem.

However, the astute physician correlates carefully what he/she has noted on history and PE with the results of laboratory tests. When there is a disagreement between the two findings, the physician opts to verify further before prescribing anything; but in most instances, it’s more prudent to treat the patient rather than the lab results.

Erroneous lab result

We remember a case wherein a patient was treated with anti-diabetic medications for lab results showing high blood sugar. Several days later, the patient was rushed to the emergency room due to severe hypoglycemia or markedly low blood sugar levels. It turned out that the lab result on which the initial diagnosis of diabetes was made, was erroneous.

The lab tests were apparently done together with hundreds as a promotional offer of the village laboratory clinic. There might have been some lapses in the quality-control with such volume of laboratory tests. This is what the DOH should ensure with whatever laboratory they assign to do the labs for the annual checkup of more than 20 million Filipinos.

Our government doctors manning our primary health centers must be retrained on how to develop their “clinical eye” further. We may be a little conservative and traditional, but we still go for the good, old-fashioned way of medicine when the “clinical eye” can actually guide one more on how to treat a patient than a whole battery of tests.

In low-resource settings like what we have in our country, we should harness our government doctors’ clinical eye more, rather than the lenses of sophisticated microscopes, scanners and X-rays.