The problem with us doctors is, we can't quite make up our minds on what constitute "health" or "real medicine".
Take this letter from Prof Feng in the ST Forum today:
Good health not just about weight, says a 'lighter' doctor
I AGREE with Dr Yik Keng Yeong ('Excellent doctors despite wide girth; July 19) that doctors should look their part.
Since my girth has been mentioned, your readers may wish to know that I have lost 10kg after three years, but am still trying to lose another 5kg, which so far has proven to be mission impossible. This is because I enjoy food, in particular, roti prata, cheesecake, char kway teow and ice kachang.
However, obesity is only one of the risk factors of poor health. Recent research has shown that about 20 per cent of obese people are perfectly healthy with normal cholesterol and blood sugar, and a good family history. They also live a long and healthy life.
My late friend, Professor Chao Tzee Cheng, used to tell me that 30 per cent of people who die suddenly of heart attacks are not obese, but they indulge in unhealthy habits such as smoking, excessive alcohol intake, lack of exercise and risky sexual behaviour, and have a poor diet and poor family history.
Good health is a lifelong journey and you start when you are young. Parents must instil in their children healthy lifestyle habits such as having a good diet, regular exercise, not smoking and not drinking alcohol, as well as prevent childhood obesity.
Good health is not a number, be it your age, weight, body mass index, how often you jog or the number of kilometres you run. It is a sense of well-being physically, mentally, socially and spiritually.
In this regard, the National Arthritis Foundation, together with a geriatrician, is organising a number of seminars and talks in the latter part of the year and next year to address issues of health literacy, active ageing and patient empowerment.
We need to change the whole concept of health, focusing more on prevention and self-management. The present debate of 'girth and health' is simplistic and does not address the more important issues of good health.
Professor Feng Pao Hsii
Chairman, National Arthritis Foundation
Now, leaving aside the fact that from the figures given by Prof Feng, about 80 per cent of obese people are NOT "perfectly healthy with normal cholesterol and blood sugar", and 70 per cent of people who die suddenly of heart attacks ARE obese (see my take on the 'fat but fit' argument here), and that Prof Feng has written in a previous letter of obesity being "a serious medical problem and [that] studies in the United States show that obesity will be the No. 1 public health problem and cause of death in five years' time", I am amused by Prof Feng's definition of good health as "not a number... [but] a sense of well-being physically, mentally, socially and spiritually".
Now much of what we do in "medicine" today is about numbers. Your "weight, body mass index, how often you jog or the number of kilometres you run", your "cholesterol and blood sugar", your smoking, alcohol intake, exercise, sexual behaviour, diet and family history are all quantified and studied, because they give us an idea of your risk for certain diseases. Our interventions, pharmacological or otherwise, aim to modify or reduce these risks. These are numbers that translate to concrete events in real-life.
You may argue that one can have bad risk factors and still have a sense of "physical, mental, social and spiritual well-being", in which case you don't need a doctor or drugs to make you feel better - but that doesn't mean you are not going to die of a heart attack at 40 either.
(I can't recall what training I had in medical school that taught me how to improve a patient's "spiritual well-being"...)
The problem with using the term "well-being" in defining something as important as healthcare or medicine, is that it is a vague term (a weasel word, I like to call it) that allows quacks to ply their trade, and for people to medicalise their problems of living - and that is something Prof Feng disapproved of, isn't it?
Do I have a better definition for "health"? Well, not yet - but I certainly don't think my job is only about giving people "a sense of well-being".
From Yawning Bread.
Thank you, Ms JS, for the link. :)
I am no longer surprised that laymen tend to judge doctors based more on style than substance; nevertheless, I am amused by how justified they feel they are in doing so, as exemplified in no fewer than 3 letters in the ST Forum today.
Mr Lee Seck Kay believes that
"... doctors need to care about their looks; never mind if they are not handsome, but at least they should not give the impression that they are lackadaisical. It is a moral responsibility that many doctors tend to neglect, much to their detriment."(emphasis mine)
Mr Anthony Goh's contribution is:
"The doctor's personality and the way he conducts himself speak better than looks."
Mr Javern Sim shares his experience and wisdom thus:
"I have occasionally come across doctors who are more interested in getting the
diagnosis and prescription of medicine over and done with, rather than
communicating properly with their patients.It is imperative for doctors to be skilful not only on the treatment table, but also in terms of patient management and communication."
(emphasis mine)
Curious. I would have thought that making the correct diagnosis and prescribing the appropriate medicine and letting the patient know the two constituted patient management and communication.Why do the writers seem more hung up on how the doctors look or conduct themselves than on the quality of the medical care or advice, as if the clinical encounter was more a date than a consultation? My suspicion is that lacking the means or inclination to assess the quality of care, patients instead base their judgement of a doctor on things they can assess. It's a natural thing to do - it makes us feel we have control over the situation - but then how a doctor looks or behaves towards you may have very little correlation with the quality of care he provides. If patients choose to judge doctors on style than substance, then perhaps that is what they will get.
The irony, of course, is that doctors too sometimes judge patients by their appearances...
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