OTGV #44 - Patient Management
Date of Broadcast: 15/12/03
Medical technology has advanced so far that equipment and newly discovered knowledge have overtaken traditional medical practic.
Two renown endocrinologists from the United States Chong Ching Liang with more.
Medicine has transcended the medieval days of harmonising the four humours; blood, phlegm, yellow and black bile to cure ailments.
Doctors saving more lives but are they doing so in the most efficient way?
Hi welcome to On the Grapevine with me Chong Ching Liang.
Biotechnology has now provided computer-aided surgery, Magnetic Resonance Imaging or MRI to peer to the tiniest of nooks and crannies that the human body can offer.
Inventions aside, epidemiological knowledge has also been gushing forward from researches and studies.
The fight against the threat of diabetes becoming a major world epidemic is an example.
Professor Willa Hsueh, chief endocrinologist of UCLA on the virtues of treating any conditions early.
"There are many chronic illnesses throughout the world. These include high-blood pressure, diabetes, cancer, arthritis. And the earlier we recognised the patients have the disease, the better we can approach treatment. Intervention early prevents damage and in the end it can save the patients a lot of pain, suffering and perhaps even an earlier death. Therefore we need to recognise some these chronic diseases as early as they appear."
Prof Willa says doctors now have the tools.
Doctors just need to learn how to optimise their efficiency.
But this shift away from the focus of a specific disease to looking at a multitude of syndrome, will it cause confusion and mis-diagnosis?
Unlikely, says Professor Willa Hsueh.
"I don't think so. The current trends in medicine allow us to recognise diseases much earlier. There are a number of epidemiologic studies, for example for diabetes and heart disease, that allow us to recognise which humans are at high risk, will ultimately getting, for example, a heart attack, stroke or diabetes."
Medical care-givers be it the neighbourhood family physicians or the specialists at any hospitals must upgrade their management of patients.
Think out of the box.
Using diabetes as an example,
"Well traditionally diabetologists and endocrinologists who treat diabetes have traditionally been what we called glucose-centric. They, in other words, concentrate on the glucose and not looked at the other risk factors. But we have to look at the patients holistically. 75% of the people with Type2 diabetes are going to die of cardio-vascular disease, and 2 thirds of those from coronary artery disease. So we have to look for the other risk factors for heart disease and that would include hypertension, cholesterol."
For instance, diabetes has a strong genetic load.
People with diabetic parents are very prone to becoming diabetic themselves.
Obese individuals mustn't be too complacent either.
These are the epidemiological studies that have arose to help doctors identify the highly at risk groups as far as diabetes are concerned.
Intervention doesn't simply mean to just simply lower blood sugar level anymore.
Treatment of diabetics must now come with a whole suite of routine.
Professor David Bell explains.
"And that also making sure the patients is on an aspirin a day, making sure those patients who are more liable for infections also have vaccination for pneumonia, that those patients also have flu vaccines. And also that we check for organ damage. Not only the eyes and the kidneys but that we try and diagnose it as early as possible any cardiac or cardio-vascular condition that could lead to acute events for the patients. So we got to move beyond glucose and obviously we have to be much more holistic in managing our patients."
It is to also check for protein leakage from the kidneys as this is an early sign of kidney damage.
It isn't a proud statistics.
The protein leakage is known microalbuminuria and can now be easily detected in the doctor's office.
More importantly, the process can be easily reversed.
But most doctors outside of developed economies don't really do this.
It may well be a question of not being equipped with the knowledge.
Professor Willa Hsueh says medical students in the
But she says more can be done.
"There are number of things that I think can be done. Number one, I think the people that sponsor medical education whether it be the government, whether it be the medical school, whether it would be, sometimes, pharmaceutical companies, or sometimes like the meeting that we are having, this AFES meeting, they need to emphasise education to the private practicing or government-practicing physicians. These are primary care doctors, primary internal medicine doctors, they need to understand problems, for example the kidney complications and what they can do for early intervention to prevent."
The other thing is for government to ensure that proper tests are conducted and for patients to be better educated.
That way patients can ask for a microalbumin test even if their doctors don't order it.
But diabetes is just one disease; there are many others that have varied linkages to other chronic illnesses.
Doctors now have the tools.
They must use them, and the patients must be less passive recipients of treatment.
They too, must learn and demand.
This is Chong Ching Liang for Newsradio 938.
Related Links:
Newsradio 938 (now 938Live)
http://www.938live.sg/
Willa Hsueh's page in UCLA Medicine
http://www.endocrinology.med.ucla.edu/willa_hsueh.htm
Ministry of Health
http://www.moh.gov.sg/
posted by CHONG Ching-liang | 5:29 PM
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