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Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Every family physician must have a clear idea in his mind, while treating and attending to anybody who enters his clinic. Just like a customer, who enters the shop with the expectation that a nylon garment will be very light for wearing, he should not be sent back with this garment sold to him, but should be convinced to buy a cotton one, with the explanation that a nylon garment is uncomfortable and not advisable in a tropical climate.

Similarly, anybody entering your clinic, should not leave with the label that he is a ‘patient’. He can be sent back with a very good feeling that he is a healthy person. Unfortunately, the doctors do just the opposite. They also create fear and suspicion in the minds of ‘clients entering their clinic’ and try to win them by showing them how they can prevent death or a deadly disease.

What is the definition of health? Nobody knows it, but, the fact that so many health check up schemes have entered the medical market, it means the medical people think that undergoing and passing a number of blood tests, X-ray and other computerised tests, indicate that the person has normal health but nobody bothers to probe deeper into his social, mental and sexual health.

Very often a person thinks that he is healthy and goes for a routine check up where silent diseases like diabetes, high blood pressure, high cholesterol, positive HIV or Hepatitis B or C viruses are picked up. Yes, this shows that a person who thinks and feels that he is healthy, can be having a silent disease including silent tuberculosis in the body. Thus, there is scope for health check ups, though there are a lot of draw backs of the same. But does this mean that if a person is healthy, then he is absolutely fit? Unfortunately not.

Everyday I see patients in my clinic whose heart, lungs, kidneys and rest of the body are absolutely normal, yet they will grumble that when they climb 3 storeys of the building, (just because the lift was not working), it was very uncomfortable for them.

If such a person had to do a brisk walk for 10 mins from Flora Fountain to CST to catch a train, he or she may not be able to do it inspite of normal health. Thus, physical fitness will depend on the amount of time a person spends on his health in the form of playing games, sports, going for regular walks, prayers or commitment to a cult (like Osho, Brahamakumaris, Radhaswamy, Saibaba, etc.) to maintain mental ‘sharpness’.

Vice versa, I see a lot of patients who are very muscular and show off their muscles and boast of their regular gymnastic activities like weight lifting and ability to swim 100 lengths of the pool and yet, on examination, I find that this person has diabetes or hypertension.

Complaints are the main reason for a person entering a GP’s clinic or a physician’s office. That person (he or she) has some symptoms in the body and is worried about or alarmed or is incapacitated or loses his sleep and peace of mind for which he goes to the doctor for help. Unfortunately, the doctor announces the name of ‘a’ disease and this person now becomes a ‘patient’.

Remember that complaints are ONLY complaints. Most of them are not necessarily due to a disease. During 5-6 years of training in medical colleges, only 10% of the complaints which are due to organic diseases are dealt with and taught to the medical students. But majority of the complaints are normal physiological variations in the functioning of the body and these are never taught. Often it takes years and years in the lifetime of a GP to learn about these complaints which are not due to a disease.

The illnesses which can be diagnosed as a "disease" are malaria, typhoid, tuberculosis, IHD, cancer, hepatitis, nephritis, etc. Even the patient of chronic renal failure may never think that he has got an underlying silent serious disease which can restrict his life to only a few years.

Finally, the differentiation between all the above can be done more easily by talking and listening to a person instead of asking for a number of blood and imaging tests, which themselves are the cause of iatrogenic illnesses, and are becoming more common day by day. This also includes nosocomial infections which are picked up in a patient who is admitted in a hospital. It is worth remembering that in the past, patients and doctors thought that hospitalisation was the best method of helping the patient to diagnose and cure his illness.

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