Tuesday, April 24, 2012


While doing a stint as an annual physical examination doctor at a local call center, I came across several conversations that amused me and not just because they were coming from educated people who answered my questions in fluent English, but that they all said it with straight faces.

Me: Any other medical concerns these days?

A: Sometimes, doc, I get these throbbing pains in my low back area. Maybe it's just "panuhot" because I sleep with the fan and the air conditioning on, and for most of the night, my back is exposed to it. So maybe that's it, siguro.

First, I really don't know what "panuhot" is anymore. I used to think they were muscle trigger points in myofascial pain syndromes. I used to think of it as twisted muscle fibers and micro-tears healing in really funny ways causing knots and felt as such in the broad sheets of back muscle. Now, people use it for anything they feel -- stomach pains, chest tightness, difficulty urinating, and a host of other bodily aches.

Second, I really don't know how an electrical appliance can cause anything. They get blamed for so many things -- fires, lost files, not working properly -- that they really shouldn't get an even worse rap for causing back pains. Except for maybe some bloatedness, I'd hate for appliances to be agents of disease because these past few days of summer have been really really hot, and most people are going to be in front of those fans and AC's for the most part of their days.

Most often those bodily aches and pains are probably muscle spasms or knots of muscle healing from microtears which heat, stretching, and proper body mechanics can't cure.A pain reliever or two won't hurt either.

Me: Do you have asthma?

A: No, doc. Well, I did when I was small, but my mother just had me play basketball and I was cured.

If basketball was a cure for asthma, I'd prescribe it 3x a day to cure asthmatics everywhere! But seriously, if I had to write down the pathophysiology of asthma and how modern medicine helps its exacerbations, this just wouldn't be a fun blog anymore. Exercise can trigger asthma. That's precisely why asthmatic athletes take their inhalers with them.

But I do know that people who exercise develop a certain, for the lack of a better word, tolerance to asthma attacks. It does this by increasing oxygen, thereby, decreasing the body's absolute need for it in times of exacerbations and what other theorists have put out there, but this does not address the airway hyperresponsiveness and inflammation that are the fundamental abnormalities in asthma.

The basic problem is, people labeling an assortment of things as hubak or asthma. Coughing = asthma. Difficulty of breathing = asthma. If you go up a flight of stairs and you are still trying to catch your breath, bouts of coughing and simply because your diaphragm is getting pushed by your full stomach after a good hearty meal is not asthma.

Me: Do you have asthma?

A: Well, I was admitted a year ago doc for pneumonia.

It doesn't really answer my question.

Asthma is not pneumonia. The former is a condition characterized by inflammation and airway hyperresponsiveness while the latter is an infection of the lung parenchyma.

Yes, it's my job to educate people so I did, and I do.

Me: Sir, after three blood pressure measurements, by definition you are hypertensive. You should cut down on your salt intake, modify your diet and change your lifestyle.

A: So I can't eat pork anymore doc?

What I usually say is that I'm a very lenient doctor and you can still eat pork, but not with too much salt or seasoning. For those of us who eat pork on a near daily basis, we pretty much know it's delicious. So I say, everything in moderation.

First, hypertension and cardiovascular disease have so much more going on than Kim Kardashian and Kanye West combined. There is salt, salt-retention, sympathetic overactivity, renal considerations, heart considerations, allowances for end-organ damage, and whatnot, that to worry about it all would be a sin to life. But let's take one small step by reducing the salt intake since it has a big role in elevated BP.

People say that eating red meat increases mortality. I say "to live is to incur the risk."

Cut down the salt, get exercise, cut down on fat, and if it doesn't help, take your medications without fail.

Me: Any other medical problems?

A: I used to have these skin allergies and wounds doc, on my hands when I was young, but it went away because, (in a hushed tone) I don't know if you believe in it doc, but my mother used the urine of a lizard with wings (tiki nga naay pako) and it just went away.

Me: ???

I just sat there with my puzzled face on.

The work, we new-generation doctors have to do is a long, long road.

Wednesday, April 11, 2012

What Not To Do When Seeing Your Doctor For A Medical Certificate

After doing some duties at an HMO clinic, I realized that the most common reason people actually come in for consults is to get a medical certificate, regardless of whether the claim of illness is legitimate or not. Mostly, these patients malinger (yes, we can tell) so that they can get their unauthorized leaves excused with pay, but some actually are sick and come in to get themselves seen, while others come in asking for a fit bill of health to return to work.

For the better part of things, I don't complain, and I'd like to give my patients the benefit of the doubt. But there are certain things that you should know when you come in for that piece of paper with the doctor's signature on it.

1. For a change, maybe you can actually see a doctor when you are actually sick. It will make our jobs easier.

2. If you're faking it, stick with subjective complaints. Saying that you have a fever with cough and colds, would work when only when we actually get a fever on a thermometer, when you're all stuffy with a nose swollen up like Rudolph, and barely getting through the history part of our examination because of a hoarse voice. With subjective complaints, at least you would have more luck if you come across a doctor who gives you the benefit of the doubt.

3. Please, if you've self-diagnosed yourself before you came in for a consult, do your due diligence and check it out. The Internet can be your friend in these things. I actually feel bad for electrical appliances everywhere, and the wind too. I think people have found them as causes of several body ailments more often than actual disease agents, like sleeping with the aircon or the fan on causing muscle pains and diarrhea to headaches. Yes we have traditional beliefs, and yes there are some truths and some baloney. It would help if you got some facts right already, so we wouldn't have to debunk everything you say.

4. Do not LIE. Or if you really really want to, do not let us find out, because if we do, it leads to number 5.

5. Probably the most important of all -- Do Not Piss Us Off. If you come in with an attitude, feeling like you've gotten the better of us, refusing laboratories and telling us how to do our jobs. Believe me, these do not help your case.

So, please, for everybody's benefit, tell the truth, give us something to work with, and don't piss us off.

This way, everybody is smiling when reaching for the door.