FITNESS, COMPLAINTS AND DISEASE
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.