Have you seen your doctor lately?
The pandemic has altered the health-seeking behavior of patients around the world. Routine care for chronic diseases is an ongoing major challenge globally, as most patients deferred their preventive or health checkups for fear of contracting the dreaded coronavirus.
Diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypertension cases were among the most impacted, as access to care is impaired to this day.
The silent killers in our midst
Before COVID, there was hypertension and diabetes, two of the leading causes of death in the country. But right now, there seems to be only one disease that we have in our midst — COVID-19.
“That’s very alarming!” exclaims Dr. Helen Ong Garcia, head of the Cardiac Rehabilitation of Chinese General Hospital. “Ignoring the other major health issues (like diabetes, hypertension and COPD) could also impact the mortality and morbidity in our general population.”
Dr. Garcia brought this situation to light during the webinar “Talk to Doc.” Supported by Boehringer Engelheim, the webinar was aimed at educating Filipinos on common disease risk factors and encouraging patients to reach out and talk to their doctors so that those who need care will get the attention they need through appropriate channels at the right time.
According to the Philippine Statistics Authority (PSA), the top causes of death in the Philippines in 2020 were heart diseases, neoplasm cancers, cerebral vascular diseases and pneumonia. “COVID-19 with virus not identified” or “with virus identified” ranked seventh and 16th, respectively.
The number of registered deaths due to ischemic heart disease and diabetes also exceeded their averages in the last five years.
“But COVID confers fear, while heart diseases and diabetes do not,” laments Dr. Garcia. “Even if people are dying from heart diseases and complications with diabetes daily, they don’t hog the headlines like the coronavirus.”
And what’s so sad about that? “Because diabetes is prevalent. It is as prevalent as COVID and every year, the number of patients with diabetes is increasing,” stresses Dr. Garcia.
Diabetes is a growing global epidemic. Records show that 11 adults globally have it, and 80 percent of the burden is on low- and middle-income countries. The Philippines ranks fifth in the region with the most cases.
Even if people are dying from heart diseases and complications with diabetes daily, they don’t hog the headlines like the coronavirus.
“It is projected that by 2035, there will be about 700 million people affected by diabetes,” warns Dr. Garcia. “That’s a 51 percent increase compared to the years before.”
In relation to diabetes and diabetes-related complications, ischemic heart disease and chronic kidney failure have significantly increased as causes of premature death in the Philippines over the span of 10 years — from 2007 to 2017.
“There are numerous symptoms of diabetes, but these will only manifest while the disease is way in the middle of the game already,” warns Dr. Garcia. “Because by the time you experience extreme thirst and urination, your diabetes might have progressed already to the point that interventions are more critical compared to prevention.”
According to Dr. Garcia, even before the patient recognizes the risk factors in developing diabetes, the process has already started.
“And 10 years before your actual diagnosis, you already have atherosclerosis, which means there are minor blockages in your arteries,” she explains. “By the time you’re diagnosed, diabetes has already caused damage to your organs.”
Just like diabetes, hypertension had been causing problems long before COVID-19. The disease comes with a high prevalence rate reported at 23.4 percent. What’s also alarming is that hypertension is no longer an old man’s disease. Patients are getting younger — some in their 20s.
And, just like diabetes, less than half of the people with hypertension know that they have it.
“That’s why early detection is very important,” stresses Dr. Garcia, who is also the section head of the Stress Laboratory of St. Luke’s Global City. “Talking to your doctor is necessary. Because when your condition has already progressed, prevention would be out of the equation.”
COPD and why it’s deadly
Chronic obstructive pulmonary disease (COPD) may not be as well-known as diabetes and hypertension, but it can also be deadly.
“The only time COPD came to public attention was when the King of Comedy (Dolphy) succumbed to the disease,” says Dr. Patrick Moral, a professor at the Department of Medicine, UST Faculty of Medicine and Surgery.
The Global Initiative of Obstructive Lung Disease defines COPD as a disease due to chronic inflammation brought about by the exposure to obnoxious stimuli like tobacco or cigarette smoking.
“It usually happens to the elderly and most of the symptoms like shortness of breath are attributed to aging,” explains Dr. Moral.
What was once considered an “irreversible” disease is now preventable and treatable.
“COPD is characterized by airflow limitation,” notes the lung expert. “Because of that, it is commonly mistaken for asthma. And so, before the doctor makes an accurate prognosis, the condition has already progressed.”
And since COPD is a lung disease, those who have it refrain from seeking medical help for fear of being identified as persons under investigation or PUI.
“It’s very challenging for us to manage COPD since it has been pushed aside by COVID-19,” laments Dr. Moral. “It also doesn’t help that COPD’s common symptoms are cough and shortness of breath, the same presentations of COVID.”
Navigating through the new normal
Still, balancing patient care and safety in the time of the pandemic is of utmost importance.
“There are many ways for patients and doctors to navigate through the new normal,” enthuses Dr. Moral.
In the absence of face-to-face consultations, Dr. Moral encourages patients to seek medical help through telemedicine or tele-consults.
“While establishing rapport between a patient and doctor can be a challenge, telemedicine is still better than not seeing your doctor at all. The only thing we demand from our patient is to give us as much information as possible for us to be able to come up with a diagnosis,” explains Dr. Moral.
According to Dr. Moral, 80 percent of the diseases can be diagnosed with a good medical history, with a good story.
“And the patients have to tell that to us,” he adds. “That’s one of the advantages of doing telemedicine. Prior to consultation, they can send me prescriptions that have been given to them and tests that had been done beforehand. So by the time we do our actual consult, we already have an idea of their health conditions.”
Dr. Moral ended his talk by sharing tips on how to “Talk to Doc” in the new normal:
Don’t hesitate. Do a self-assessment; if you think or feel you have underlying conditions. Better to manage your health conditions early on than wait for an emergency to happen.
While establishing rapport between a patient and doctor can be a challenge, telemedicine is still better than not seeing your doctor at all.
Reach out. If you already have a doctor helping manage your condition, reconnect. If you have yet to find a doctor, there are many ways to connect with one. Ask for referrals. Your family and friends may already have trusted doctors to recommend. Call the hospital. The reception will gladly give you options. Key is to reach the doctor’s medical secretary.
Connect with the medical secretaries. They’ll guide you throughout your journey, until you get to talk to doc.
Talk to the doc, whether it’s face to face or virtually. Make a list of the things that you want to consult and ask. If it’s a face-to-face visit, make sure to follow the IATF minimum health protocols. If it’s a virtual consultation, try to understand how the platform works. Try it out. Make sure your audio is clear, signal is stable, and gadget is fully charged.
Follow the doc’s advice, whether it be doing labs, taking meds, turning to a healthier lifestyle or checking back in for a follow-up consult. Talking to a doc alone just won’t work if you do not follow the care he/she prescribed.
Strengthen that partnership with your doctor in caring for your health. Having a healthier community to battle this pandemic starts with you. So do not delay. Talk to your doctor today!