Your doctor is unlikely to be your Facebook friend

Social media is a great platform for maintaining both personal and professional connections. You will find all conceivable businesses maintaining active pages on Facebook, Twitter and several other social platforms.Doctors too are increasingly trying to maintain an active presence on social media.

But any connections between doctors and their patients must maintain confidentiality, and not blur the clear lines between professional and personal relationships. Many physicians have professional pages on Facebook. This should not be viewed as any different from other professional businesses. But the content differs in several ways. Physicians’ pages are more focused on general health information, and how to access their services. Don’t expect to find your doctor sharing private matters like fancy weekend photos, or anything else that may be deemed intimate. They may have such content on their more private Facebook accounts, which you should not expect to be part of.

From your viewpoint, connecting with your doctor on Facebook makes a lot of sense. You can easily keep up to date with basic health tips, and in some cases ask some general medical questions or Inquire about appointments. But you should know where to draw the line. Keep within professional boundaries, and don’t delve into more specific health matters that may be troubling you.

Remember social media communications are generally insecure, and anybody out there may stumble onto some information that should be kept confidential.All confidential, intimate and complex medical communications must always be via digitally secure systems.Or in person at your doctor’s office.

But others have questioned whether purely social interactions between patients and their doctors should be outlawed. You and your doctor may have built a trusting relationship over the years, and may feel compelled to connect in other ways. There are no legal restrictions for such social media interactions, and some medical authorities have left the question open.

But a line must be drawn, and both you and your physician must limit what you are willing to share on social pages. Once professional lines are blurred, your relationship becomes something else.

I personally receive many Facebook ‘friend’ requests from some patients, and so do my colleagues. Don’t get offended if neither of us responds positively. I personally just ignore such requests, but always strive to pass on any relevant medical information and general advice. The opposite is also true, majority of doctors will not ask you to ‘befriend’ them on Facebook if you have been their patient. And if they do, you are at liberty to just ignore their requests as well.

Professional interactions must always uphold certain principles. You and your doctor know very well what those principles are. There is never any excuse for breach of confidentiality, or inappropriate relationships, even if it happens in cyberspace.

Excessive drinking, not just about Mututho laws

The debate about the merits and demerits of the famous Mututho laws on drinking is not about to end. There will always be a counter-argument. It matters little who puts in a better reasoned point of view, the issue at hand is our long term health in the face of alcoholism.

The ills of drink driving are self-evident. The horrific scenes witnessed by many the morning after are all too graphic. What with too many deaths, broken bones and lives changed forever?

There is no good reason for this to continue happening. Any measures to save more lives should be welcome. But motor accidents are just a tip of the iceberg when it comes to less graphic, but equally lethal effects of alcoholism.

Enjoying alcoholic drinks within the recommended weekly safe limits is fine. But there is a very thin line between keeping to safe limits and going over the edge into constant inebriation.And that’s where the problem lies.

The long term untoward health effects of excess alcohol consumption are well known. You run the risk of liver disease, cardiovascular disease, mental disorders and nervous system diseases among a host of many others. Antisocial behavior is not spared either. That’s where crime, poor performance at work and relationship breakdowns come in. No wonder premature deaths related to alcohol are on the rise.

Neither Mututho, nor anybody else for that matter, can force you to drink within safe limits. This is a decision you alone must make. There are many ways to escape getting caught while driving beyond limits. Am not about to divulge any clues here on how to beat the law. What you will not escape is the slow but sure damage that will inevitably overwhelm your organs. You can drink-drive all you want, and possibly never get flagged down or get caught up in a grisly accident. But you will slowly succumb to a lesser graphic effect of your alcoholic ways.

So how can you help yourself? The first step is to take stock of how much you are drinking presently. Reduce the amount at every drinking session, order a soft drink or water when the next rounds come. And drink less frequently during the week. You could substitute going to the pub with a new activity, like getting home earlier or volunteering for a needy cause. You could choose to change your company as well, and hook up with teetotalers for a change. If already over the edge, you need professional help. Call up your doctor, and consider joining a support group. Alcoholic anonymous will happily accept your membership.

It is in your self-interest to keep your alcohol intake within safe health limits. The law is an ass, make your own in matters of health. You will then not need anybody policing whatever you imbibe and how much. You will always be within healthy limits.

Your doctor’s age may be lethal

Doctors are among a unique group of professionals who work till they get to a ripe age. It’s not unusual to find doctors in their 7th or 8th decades still running busy clinical practices. But questions often arise about the quality of medical care provided by increasingly older doctors.

The question about advancing age and continued medical practice is not new. But a newly published study has again brought the matter into the spotlight. This study looked at patient outcomes following admissions and treatment in US hospitals. Among the items under observations were mortality (or death) rates, readmission rates, and costs. Key findings indicated that patients treated by older physicians had higher mortality rates, with the exception of older physicians who had high volumes of patients. The costs of care were also slightly higher with older physicians.

But how old is old? In this study, physicians aged 40 and below had the lowest mortality rates, while those aged 60 years and above had the highest mortality rates. But why is this the case? You would intuitively think that older physicians have more experience, and you would naturally expect them to have better outcomes. But this expectation was not supported by the study observations.

Well, the supposition is that older physicians might have decreasing clinical knowledge compared to their younger counterparts. The older ones may also still lean on outdated skills, and not be readily up to date with newer models of care, and novel medical technologies. Still the more aged physicians may not subscribe to current clinical guidelines, and may perform worse on quality processes that intertwine diagnoses, screening and preventive care.

It appears the better metrics with younger physicians are linked to more recent training. But other metrics may favor the older physicians, like communication with patients and more restrained invasive interventions.

Should these study findings suddenly prompt you to review the age of the doctors you currently see? Well, there are many facets to overall quality of medical care. The individual doctor matters. But more importantly, the culture of quality and safety in the institution you get your care from matters much more. Other notable studies have shown that healthcare institutions, with sound quality processes in place, create desirable patient outcomes regardless of variation in the clinical performance of individuals.

There are other safeguards in place to keep you safe regardless of your doctor’s age. Maintenance of medical licensing legally mandates doctors to keep themselves up to date with changing medical practices. The advent of team-work, with shared skills within medical specialists, keeps you within the confines of optimal care. But you must also play an individual role in selecting your physicians. The oldest is not necessarily the most skilled, or experienced. The youngest may be the most medically tech savvy, but they may not necessarily make the most objective clinical decisions.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

New Year health resolutions that count

It’s now only days into the New Year 2019. As a tradition, many individuals review the past year’s events, and come up with a list of resolutions for the coming year. Towards the top of that list should be a firm resolution to lead a healthier life.

Make a resolution to attain and maintain a normal body mass index (BMI). BMI is a computation of weight and height, and is directly related to many disease conditions. BMI calculators are freely available in many health facilities or online, individuals just need to input their height and weight to come up with their BMI. The ideal BMI is between 19 and 25. The higher the BMI, the more the risks of cardiovascular disease and adult onset diabetes. Women with high BMIs are less likely to ovulate regularly, meaning potential problems with fertility. There are also more pregnancy complications with high BMIs and increased risks of cancer of the lining of the womb.

Women’s screening tests for early detection of cancers and other diseases have been proven to save lives. Resolve to keep all screening tests up to date. Pap smears and mammograms, that detect cervical and breast cancer respectively, have specific screening intervals which are best adhered to. Your Gynecologist may recommend other non-routine screening tests depending on your specific circumstances.

As women (and even men) grow older, fertility potential declines. This is more so after the age of 35. If approaching this age and you harbour desires for a family, you may choose to make a specific resolution in this respect. Timings for starting a family often conflict with career and other social plans. If the timing for such a resolution is not ideal, you could always discuss fertility preservation options with a Fertility Specialist. This may give some future options when the timing is right. If already pregnant, resolve to keep all your antenatal care appointments.

If you happen to have any on-going Gynecological disease, make a resolution to get to the bottom of it. Many Gynecological diseases can be controlled with conservative measures, while others may need more intensive interventions like surgery or long term medication. Resolve to seek out the best health facility, and the most qualified Gynecologist you can afford to consult. Seek second opinions if necessary.

This list cannot be exhaustive. Other general health resolutions include stopping smoking, reducing alcohol intake, limiting use of recreational drugs and practicing safe sex. You can resolve to be in command of your health, or just allow yourself to drift with the current. Be healthier in 2019.

Chickenpox exposure in pregnancy should be avoided

Exposure to infectious diseases should generally be avoided if at all possible. This is more so in pregnancy as infectious diseases may pose complications both to the mother and her unborn baby. Chickenpox is one such infection, pregnant mothers should as much as possible avoid contact with anybody infected with chickenpox.

Chickenpox is a childhood viral illness, usually causing mild symptoms that include fever and a rash. Childhood chickenpox infection confers lifelong immunity, meaning that one cannot get infected a second time. People living in the tropics are less likely to have had chickenpox in childhood. Infection in adulthood tends to be more serious. A chickenpox vaccine is available for the non-immune, but cannot be given in pregnancy.

Chickenpox risk in pregnancy depends on the stage of the pregnancy at the time of infection. The mother may suffer severe symptoms necessitating hospital admission, while the baby is also at risk. If exposed very early, there is a small risk of damage to the growing baby’s eyes, brain, limbs and abdominal organs. If the infection occurs between 28 and 36 weeks of pregnancy, the growing baby does not usually suffer untoward effects. But after 36 weeks and around the time of birth, the baby may become severely infected with chickenpox necessitating treatment after the birth.

There is thus enough reasons to avoid potential exposure, especially if unsure about having had childhood infection. Mothers at risk of exposure tend to be the ones working with children in day care centres, nurseries, schools and in hospitals. If working in such set-ups during pregnancy, one should request temporary relief from duty to avoid contact with any infected children.

What if one inadvertently gets into contact with an infected individual? If it’s clear one suffered childhood chickenpox infection, then nothing needs to be done. If however there is no indication of ever having had chickenpox, or there is any doubt, one should immediately contact their Obstetrician. The Obstetrician will arrange some blood tests to confirm immunity. For those not immune, an injection may be given to reduce the chance of getting infected. If infection has already set in and blisters have developed, treatment with anti-viral tablets may be given. One should avoid contact with other pregnant women or small babies in order to avoid passing on the infection.

The timing of delivery following infection with chickenpox depends on individual circumstances. It’s best to delay delivery till recovery, and this also gives a chance for immunity to develop and pass into the unborn baby.

Breastfeeding is safe once the baby is born. The baby however would need an eye examination and blood tests. If infected, the baby would also need specific treatment. A blood test seven months later can confirm development of chickenpox immunity in the baby.