‘A good doctor is also a good psychologist’

Each era has own features, which find reflexion in daily routine. The socially significant sphere of medicine seems to be changing relationships between patients and doctors. Tatiana Zhukova, an Associate Professor of the Chair of Medical Examination and Rehabilitation at the Belarusian Medical Academy of Postgraduate Education and Candidate of Medical Sciences, is a well-known gastroenterologist. She discusses her views on such issues as patient confidentiality, people’s readiness to seek medical advice and whether we are doing a good job of looking after our health.
How would you describe patients today? Have they changed over the last 20 years in terms of their health worries?
Certainly, they have changed. My opinion is affected by my working experience in Minsk, where residents have access to more information, and tend to travel more abroad. They have more opportunities to become informed and, consequently, tend to be more concerned about health issues. In fact, many come for check-ups simply to ease their worries, rather than for any particular ill-health reason. It’s a good trend, especially among the elderly. Even young people come to see the doctor, as they have great plans for the future, and don’t want health issues to interfere.

Your own medical field revolves, in many respects, around people eating well. What advice would you give regarding nutrition? 
I’m sure I’m not saying anything new in reminding you that we don’t need to spend a lot of money in order to eat healthily. Some wealthier patients, who have good careers, admit that, in buying more expensive products, such as smoked foods, they feel less healthy than they did before. It’s important to eat vegetables, fruit and fish, with as few preservatives as possible. At least four or five portions of vegetables and fruit are ideal; I know that it’s not always possible, but we should aspire to this. It’s a pity that some only pay attention to their health once problems arise. Doctors can only give medical advice; it’s up to patients to follow their suggestions.

Our modern, busy lives can lead to stress and grabbing food ‘on the go’.
I always say that it’s important to keep everything in perspective. Follow medical advice, but don’t become obsessive. If you hold yourself hostage to healthy living, even small departures can bring stress. Try to keep a reasonable balance. It’s said that doctors can help to solve patients’ problems in just 10-15 percent of cases; the rest is down to people’s own choices. I’m not talking about emergencies, which need surgical intervention. There are a great many illnesses we can avoid by simply following a healthy way of life. Doctors can give advice but patients are responsible for their own health.

What sorts of problems do patients bring to you and are you seeing any trends?
There’s such an illness as gastroesophageal reflux disease (GERD): when the stomach contents are thrown into the gullet. Its major symptom is heartburn. International data shows that about 70 percent of people living in industrialised countries may suffer from this. Stress can exacerbate the situation, and the quality of life of such people suffers even more than that of people with myocardial infarction. It’s a serious problem and a growing trend. Esophageal ulcers and erosions are becoming more common.

You’ve probably seen adverts stating that heartburn is caused by acid, which needs to be neutralised. However, acid is normal. The problem arises when stomach contents are thrown upwards. We often have patients suffering from extra-esophageal signs of GERD. When acid from the stomach is thrown upwards, the mucous coating of the upper respiratory tracts is damaged. Extra-esophageal signs of GERD are pharyngitis and dental problems. Otolaryngologists are more often than ever sending us patients with such problems.

Moreover, eating disorders and obesity are also common (this can lead to fatty hepatosis — a fatty liver). If your cholesterol levels are high, your liver becomes enlarged, leading to inflammation and hepatitis.

However, we’re seeing fewer situations of surgery being required, largely because of preventative measures — such as for helicobacter syndrome. I’m seeing fewer severe illnesses. With adequate therapy, we can save a patient from chronic gastritis.

Are you guided more by world standards of medical science or domestic expertise?
We rival international levels of advanced medical science, with the necessary drugs and competent doctors. We are familiar with international recommendations and use them in our work, so I’m convinced that our medicine is at a high level and that our specialists are very good. Those seeking qualified medical aid receive it. Maybe, our doctors are even more professional than in the West.

Is there really a problem with obesity in Belarus?
We used to say people had metabolic syndrome but new, international classifications don’t recognise this. If you are overweight, you may also have high blood pressure or high cholesterol levels, impaired glucose tolerance or diabetes: all serious problems. Paediatricians are ever more concerned by the number of children suffering from obesity. I’ve witnessed the trend myself. During a conference in Kyoto, I flew from Tashkent to Osaka. I was the only European among Japanese tourists and saw that those of elderly age were short in height but slender; they looked a little fragile. However, the younger Japanese were much plumper — some even obese. It’s a consequence of modern American and European fast foods. Obesity is a global problem.

What changes occur in our body when we put on weight?
It’s all pretty obvious; if you eat too much, the calories start to deposit as fat and excess weight appears. In order to get rid of it, you have to exercise but, as I try to explain to patients, lifting weights is not for everyone. Overweight people tend to have cardiovascular problems so cardio exercise is more useful: walking, for example. Lifting weights may aggravate their problems.

Can modern fat burning drugs help reduce weight without dieting?
If people follow an unhealthy diet, drugs won’t help. If you have a very high degree of obesity, a doctor is compelled to prescribe certain drugs, since irreversible processes may occur. Dietary recommendations are made and increased physical activity is recommended but reducing weight too quickly can have serious consequences.

How would you sum up our conversation?
We are seeing more people taking care of their health and co-operating with doctors. It’s a relationship whereby we must work together to solve problems. My own experience is that increasing numbers of people are ready to listen to their doctor and follow medical advice, which is good. People used to think that their doctor was responsible for ‘curing’ them; now, more patients are interested in their health and understand how problems are interconnected, so they are willing to view their doctor as a partner and friend, helping them to solve their problems. Of course, some people will always avoid going to the doctor, or being honest with them, which hinders progress. I want to underline that a good doctor is also a good psychologist. You need to extract information and listen, learning as much as you can — even before any medical tests. If a patient trusts their doctor and is willing to follow medical advice, there will be success. 
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