Physician tells us three things patients with chronic diseases should not forget

How to Use Your Neighborhood Hospital

 

Song - Right.

 

 

Ji - If the local hospital fails, there may come a time when the public will suffer damages.

 

Song - As of now, there is no way. Right now, as far as I'm concerned, it's a red ocean of red oceans. But on top of that, there are a lot of people who think doctors have a vested interest. Maybe it's a vested interest, but it's constantly instilled in me that it's a vested interest. There's no way out of that situation.

 

So, actually, as the people who are coming out of the doctors now, as I said at the beginning, when they go in, they think, 'I'm going to stay at the university and do research, train students, and treat patients,' but very few people can do that. Eventually, you have to go out into the neighborhood, and it's a sad situation.

 

 

G - Recently, there have been a lot of broadcasts related to medical examinations in the rain. You said that the medical examination conducted by the National Health Insurance Corporation does not include a medical examination. When you get tested, you only know the numbers. How should I make good use of my health checkup?

 

Song - After a medical checkup, I ended up at the local hospital. There's a hospital that you go to often. I'll take the results and see if the test matches my usual symptoms or anything like that, or if it's a watermelon scratching test.

 

If you need to, you can get a kind of test prescription from them that says, "I want you to have this or that test."

  

But you can't do everything through a national screening. It's dealing with a very large population for the cost, so it's not like doctors are going to say, 'We need to put this in the national screening.' That's a no-brainer.

  

The latest addition is that it allows people who have smoked for more than 30 years to have a CT scan. Strictly speaking, it goes against equality. People who don't smoke don't have a chance to get a CT scan. Some of them may develop cancer, which may not be detected.

 

By taking a CT scan, even though it's not cancer, you can do the test uselessly and increase your medical expenses. That's why it's not easy to increase the number of health checkups.

G - You'll see a lot of patients with adult diseases, hypertension, diabetes, and hyperlipidemia. Since there are no symptoms, it is difficult to go to the hospital, and once the symptoms appear, it becomes difficult to turn back.

 

Song - In the end, the answer is a local hospital. The one that can be found quickly is the local hospital. When I go to the local hospital, they ask me to check my blood pressure when I go for a cold. You can check your blood sugar at your fingertips. I don't know anyone who doesn't have a blood test once a year. You can ask them to test for hyperlipidemia.

 

That's why our average life expectancy has increased dramatically compared to the past. I think that's partly due to the local doctor. And so it was cardiovascular, cerebrovascular disease, and cancer, but early detection prevented a lot of people from dying from complications.

  

In the case of hypertension and diabetes, the general public is aware of it to some extent, but to be precise, there is still little awareness of what is called dyslipidemia (hyperlipidemia). Doctors have to put a lot of effort into that.

 

It's not a disease that can be cured, so you have to keep taking medicine. If the test results are good, they often don't eat it. Still, only about half of people diagnosed with hypertension or diabetes are well treated. Only half of those who receive treatment are well controlled.

 

 

G - It seems that it can be controlled by taking medicine, so there are many cases where you don't take it just because you feel better? I've heard that blood pressure medications usually last 12 to 24 hours.

 

Song - Not necessarily. What the general public thinks is wrong. We know that high blood pressure and diabetes are bad things. Ordinary people think that if they take a lot of medicine, they will have a big problem.

 

That's not true. It doesn't matter if you take less medicine or more medication, you have to eat enough to keep your blood pressure and blood sugar within target.

 

Everyone responds differently to medicines, and everything that can be learned from the absorption rate and the kinetics of the drugs that work in our body is different, so you have to take the amount that is right for you.

 

I think that's probably going to be a problem in AI later on. For example, if it's 140 or higher, the AI will give you blood pressure medication, and if it's 141, the AI will give you the medicine unconditionally. But doctors don't have to.

 

 

G - Many people think that once they start taking medicine, they can't stop taking it.

 

Song - You're wrong. I keep taking it because I have to take medication. It's not because you've taken medication that you have to keep taking it.

 

That's ridiculous. If you have to keep taking it because you took the drug, what kind of drug is that? You can think of it the same way as rice. Why do you eat rice? They eat because they're hungry. Then, if you're not hungry, you don't have to eat.

 

The same goes for blood pressure medications, diabetes medications, and hyperlipidemia medications. If you don't take medicine and it stays normal, you don't have to take it. I don't do that, so I eat it. You don't keep eating because you've eaten, you have to eat, but a lot of times you're not eating.

 

 

Three things people with chronic illnesses shouldn't forget

 

Song - The opposite of a student is a teacher. A teacher is a teacher. But doctors don't teach their patients. It's correcting what is wrong with the patient. Tiger Woods or Michael Jordan don't have a coach? There is.

 

For what? He doesn't know that he's going slightly wrong. Then you can look at it from the outside and correct it. Something's going wrong right now, you have to come this way, you know.

 

  

G - In that sense, you've talked a lot about the patient's attitude toward illness. I'm sure you've seen a lot of patients with problems.

 

Song - It's called a bottle meal. It's called awareness and insight into illness. Most patients forget that they are patients.

 

Not only chronic diseases such as hypertension, diabetes, and hyperlipidemia, but we all know about the end of any disease because there are many pathways of disease knowledge that the general public can now get.

 

Then, if you are a patient and you act as if you are not a patient, you are bound to go in a bad way.

 

But I keep forgetting about it. That I am a patient. I don't think people who go to a university hospital once every six months with high blood pressure or diabetes don't have to go to a university hospital.

 

I need to go to the local hospital. If you don't go to the hospital for six months, you forget that you're a patient even though you're taking your medicine. Once a month, he goes to the doctor and sees the doctor's face, so he forgets that he is a patient. It's better to go every two weeks.

 

 

G - You used to say that "internal medicine is the last line of defense."

 

Song - Don't you really feel it? They have surgery in a big hospital, or something goes wrong in the middle of the process, and they come down to the intensive care unit.

 

The first thing I do is consult an internal medicine doctor. If they do everything they can and it doesn't work, then the internal medicine department takes over. We are all comrades-in-arms. If we collapse, the patient will die. It's only for university hospitals.

 

I don't do that now, but there are times when I really don't want to take it. Oh, that patient looks like he's going to die, but I still have to get it because it's an internal medicine doctor.

 

On the other hand, when we look at a patient, for example, a patient with heart disease who was on antithrombotic drugs had a brain hemorrhage. Then, of course, you have to go to the neurosurgeon and hold him by the crotch of his pants and beg him to perform the surgery.

 

By the way, the neurosurgeon has also been using antithrombotic drugs, but when I open my head, the blood doesn't stop and it will continue to flow, and I expect the results to be not good, but I will do it anyway. There are many such cases in internal medicine compared to other departments.

 

 

G - Is there a particular increase in patients during the pandemic?

 

Song – I don't know. There is no significant increase in the number of patients. On the contrary, because of good personal hygiene, the number of patients with acute upper respiratory tract infections has definitely decreased. At the local clinic, it doesn't matter what department it is, and the people who come to me come to me with other problems.

 

I think there are some cases where I get dermatitis from using a lot of masks. It's a disease that wouldn't have existed if I hadn't been wearing a mask. I order a lot of delivery food, so I sometimes get intestinal infections. And chronically ill people say they're afraid to come to the hospital and ask for more prescription days. (laughs)

 

 

JI - You said, "During the Corona period, you should not go on a diet that can harm your immune system." There are people who eat a lot when they are stressed.

 

Song - Eat less. It's the same as your bank balance. Once it's in my body, whether I consume it or let less of it in, that's the most important thing. One of the best ways to relieve stress is to eat.

 

 

G - I know, but I can't. (laughs)

 

Song - Because it's easy.

 

"Get a Hospital Notebook"

 

Song - I put all my records there. If you know when and what you got vaccinated, you can tell them that you've done this before, so please get vaccinated like this in the future. I'm talking about cases where you don't have a particularly serious illness.

 

When are you going to do a follow-up test, you know. The more records the hospital has, the more the doctor learns about the patient. It gives you more depth to give advice.

 

But if there are several local hospitals, one time I go here, one time I go here, and then the records are divided, and that's what makes me feel the hardest. I went to the university hospital and got tested. What did you do? They did a blood test. What did you do with the blood test? Of course not.

 

However, those who are properly educated by me are examined at the university hospital and taken at a cost. Then I can explain it in more detail than the doctor there, and that kind of record will accumulate in our hospital. Then, when something happens to the patient, the record becomes a very valuable asset.

  

 

G - Once you get to know the patient well and trust them, you will be able to say more to them.

 

Song - That's patient education, at the end of the day. You have to approach the disease in a certain way, if it's a battle, it's a fight, and if you control the disease, it's control. I'm coaching you to make sure that it's to your advantage to do that in a certain way.

 

Wouldn't those who follow that coach have good results? Of course, even among them, complications can arise unexpectedly that we don't expect. But it's a lot less.

  

 

Ji - Apparently, you write columns, are very active, and are famous, so some people bring all their medical records and just go for counseling.

 

Song - Yes.

  

 

G - It must be bittersweet. (laughs)

 

Song - It can be bittersweet, but on the other hand, I wish he was really curious about that. (laughs)

 

I don't have enough time for it. If I talk to him for an hour, I can see 10 people for an hour, so I'll pay 10 people, and if the patient pays that much, it's enough to do it.

  

 

G - In the current situation, the cost is the same no matter how much time it takes, so that's a problem, shouldn't that be changed as well? (laughs)

 

Song - Can I change it? (laughs)

 

 

G - You have questioned the need for sleep endoscopy (sedation endoscopy). Normally, I think I would prefer a sleep endoscopy because I think it would hurt.

 

Song - You did everything when you didn't have that. One of the characteristics of our country, our people, is that they are very dexterous. Everything, whether it's the Olympics of Skill or the Olympics of Sports, whether it's manual dexterity, archery, things like that, doctors are very dexterous. Maybe it's because I'm Korean. May be. Endoscopy, even a biopsy, usually takes less than 10 minutes.

 

However, while doing endoscopy to sedify consciousness, there are people who become addicted to propofol.

 

Or for example. In some cases, surgery may be performed endoscopically. I'm not saying that you shouldn't do things like early stomach cancer surgery because it takes a long time. I don't think it's necessary to do an endoscopy just for a health checkup. Maybe that's a way to make your doctor worse and worse.

 

And in my case, I have never been properly trained in sedation endoscopy. Basically, I think it's right not to do what I don't know. I've actually done endoscopies in well over 2, 3,000 cases.

 

When a doctor does something, he has to show them what to do when it's at its worst.

 

I'm good at sewing at the end. Of course, it will take some time to learn with the right hand, but you can sew it beautifully. But of course, the stitches heal well, the stitches are loosened, and the treatment is over.

 

But if it gets an ulcer or the wound gets worse or something like that, I don't know. Why didn't I go that far? When you're an intern, you don't learn that much. There's no reason for me to go so far as to look at it and get stitches.

 

In order to perform sedation endoscopy, we need at least a bronchial intubation device in our hospital. Shouldn't that be the basic thing? I think there are internal medicine teachers. But endoscopy isn't just for internal medicine teachers.

 

If you have a doctor's license in Korea, it's the same all over the world. Because as long as you have a doctor's license, you can practice all kinds of medical practices. I'm very worried. Especially since I don't do endoscopy right now. I've done a lot of endoscopies, but every time I do, I get so worried. What if I miss early stomach cancer? Early stomach cancer is a disease that can be missed.

 

The doctor may not be able to see it. And yet, it's always like, 'I should have done a biopsy,' and when I pulled it out and the test was done, I regretted it, and now I don't do it, so it's great. It's so good. (laughs)