Take care of yourself … You are now the first manager of your health check-up

Even if we feel good, Dr. Good advises to worry each year of his tension and his sugar level which lead to diabetes and hypertension, the two main silent killers. “I take a blood test once a year to control sugar, blood cells, cholesterol, fats and kidney functions. It is essential. And of course, I do not smoke and I play sports, two parameters that avoid 40 % of cancers. Stress in our societies is increasing: eating well and moving it can decrease it. Everyone is their first doctor. Thanks to COVID, many people have finally realized that they should take care of them and that the doctor will not take everyone by the hand, ”poses Michel Cymes. However, this overall roadmap is only applied for reasonable people.
Not cars to revise
Doctor Cymes’ user manual remains general. Periodic check-up, systematically performed, with a very wide and standard test battery (the same for everyone) has not shown its effectiveness to improve your health. “Human beings is not a car which we maintain every 10 or 20,000 kilometers. We are not machines, we are human bodies ”, retorts Cassian Minguet, head of the academic center of general medicine of UClouvain and family doctor still in activity.
Check-ups are mainly used as part of an examination for life insurance, enter an administration, become a firefighter. “The risk of a“ routine ”check-up is to discover things that potentially are not dangerous, small anomalies of life that should not have been taken care of by medicine, but which will generate stress and additional examinations. We experienced thorax scanners and abdomen to everyone to see periodically if we discover something. It was counterproductive. The exams must be justified. Either a risk factor or an anomaly that we discovered in the patient. ”
In fifteen years, the chances of cancer survival have increased from 63 to 68 %
Periodic health examination whose maturity and frequency are decided by the doctor on the basis of risk factors is however essential. The family history of diseases are crucial indicators. If the parents have suffered from cancer or a cardiovascular problem, for example, a close periodic examination is essential.
“Belgian general medicine is a personalized medicine where each patient is special. The periodic examination is very well done and compulsory in small children, with a health book and vaccines. We then lose them in adolescence. Some will only come back to an advanced age, deplores Cassian Minguet. Your general practitioner must be your reference. Specialists do their part. Ophthalmologists are making the health of the eye. They give you appointments every year if you have a problem. Gynecologists and pediatricians, the same. It is very good, but only if there is a person who takes care of screening by ensuring that there are no shortcomings somewhere. ”
Three screenings are however organized directly by the Wallonia-Brussels Federation: uterus, breast and colorectal cancer, for which systematic prevention has proven itself. One in three men will develop cancer before her 75th birthday and one in four women. The increase in survival after a diagnosis of cancer, increased to 68 % of survival against 63 % fifteen years ago, is due to two major factors: progress in research but also early screening. We heal much more often from breast cancer thanks to treatments that have evolved considerably but also thanks to screening that women follow mainly from 50 years.
“Fixed file”, these health homeless
This is not the case with colorectal cancer screening (large intestine), however, systematically sent by post to people over 50 and which takes 3 minutes. The results are available after 7 days at his general practitioner. Taken in time, it is healed in 9 in ten cases. Unfortunately, today is the second cause of death linked to cancer in our country. Almost half of people do not test. The taboo around this cancer explains only part of the problem. The absence of a reference doctor and a global medical file – or a doctor for go – is there for many.
This is the first key to preserving your health: it is essential to have a general practitioner who follows over the very long term by bringing together all the reports, tests and results, including those led by specialists. For this purpose, since 2001, everyone has the opportunity to open a global medical file (DMG) to a general practitioner of their choice. The DMG has been computerized in 2016. Its use has been compulsory since 2021. The patient can since then consult him himself too, which gives him crucial info to “be his first doctor”. If 90 % of Flemish patients have a DMG, 84 % of Walloons have one and only 70 % of Brussels residents. These proportions reported by the IMA atlas (the agency which brings together all the mutuals) have increased but remain too low for French speakers.
“The Belgians are divided between those who have a regular attending physician and the others who do not know who go to see”
“The Belgians are divided between those who have a treating doctor and the others who do not know who go to see. This is why we want 50 % of general practitioners in the population of doctors. The shortage of general practitioners harms care ”, denounces Anne Gillet, vice-president of the Belgian group of omnipractians (GBO), the main union of generalists, but also a doctor on the ground. The numerus clausus was a disaster in the face of the aging of the generalists.
And it’s not about to arrange. Of the approximately 14,000 generalists alive, only 9,615 still exercise. A quarter of the latter are more than 65 years old. And the next generation no longer plans to work 60 hours a week to receive everyone. Suddenly, it is difficult to have an appointment (let’s not talk about a regular general practitioner) in Brussels, Antwerp or in rural areas as in the province of Luxembourg.
More disadvantaged, more sick
The Flemish general practitioner takes care of 1,813 patients per year, against 1,215 patients for the Walloon general practitioner and 1,306 patients for the Brussels generalist. In reality, if the Flemish doctor “ships” his patients a little faster, it is also because he practices more often with a team (physiotherapist, nurse, welcoming) and because he has fewer disadvantaged patients.
However, a disadvantaged population is more often sick, has more chronic diseases and is less educated. So she takes more time. In the same vein, nearly seven Flemish has twice a year with the dentist – a guarantee of preserving his oral health – against six Brussels residents and in ten Walloons. We see on average between five and six times a year our general practitioner. It also means that some patients never go there and others, all the time.
If vigilance is essential today, obsession is not. However, hypochondriacs have been more numerous since the health crisis in a climate of multiplied anxiety, in particular through crazy information on vaccines. These are “impossible” patients. They require examinations that exacerbate their anxiety that the doctor only manages to calm new exams … which worry them. At the same time, more and more patients (reasonably anxious) are doing online research from their symptoms or to understand their diagnosis.
Patients “better” informed
Many doctors are annoyed, others realize that it is a new deal that must be seized, like Anne Gillet. “Doctors have fought for years against self-medication, instead of accompanying him,” she deplores. We can only be delighted that people inquire and are increasingly intelligent with regard to their issues. I ask them to come with their information. We can then see what suits them, what is customizable and what is not correct from sites that are not sufficiently extensive or serious. ” Of course, to lead this participative approach, it takes time to consult. “Today health is collaborative work. There is not the doctor who knows and a passive patient. ”
Nevertheless, if the internet informs, it does not treat. At a time when no one is going to confide in a priest, when solitude grows and individualism isolates, the medical office is often the last place where to place its body … and its heart. Being healthy is as much physical and mental functioning. Depression can be due to a thyroid problem. Stomach aches can be caused by sexual mistreatment. “I had an 80 -year -old patient, who has always been single, who revealed to me, for the first time in her life, the rape she had suffered at 21. She had never told anyone, says Anne Gillet. But for that it takes months of an extremely attentive relationship. ”
Overwhelmed emergencies, risk multiplied
The number of patients with flu symptoms has reached its highest level in five years. However, the problem is mainly chronic.
The generalists are overloaded and the emergencies are overwhelmed. “Independently of the flu, we have an upsurge in Covid since September, without forgetting the Covid Long which is not a joke. But above all, this is attributed to a population of which half of which is now suffering from a chronic disease, therefore at risk of complications, ”says Lucien Bodson, emergencyist expert in disaster situations. Beyond the winter factor, the problem is endemic. “In twenty years, we have gone from 2 million contacts per year to the emergency room to almost 6 million. Some patients come several times. About 3.5 million Belgians go through emergencies each year. ” With a snowball or nerve ball effect. A quarter of the patients taken care of by emergencies would require hospitalization that does not follow.
The more the lives lie down, the more the risk of health problems, and complications, increase. 80 % of seniors have one or more chronic diseases. Our country has 2.5 million hypertensive of which half of which ignore it until a cardiovascular problem informs them if it is not fatal. This silent epidemic, for lack of preventive monitoring is linked to excess weight and stress, two in full increase which directly influence blood pressure. The same goes with diabetics, another silent disease as long as screening is not carried out. A million Belgians knowingly live with diabetes. There would be much more. The overall ballot of our health is deteriorating. “In fifty years, we went from 10 to 50 % of allergic people. This means that half of the population has degraded immunity. ” A million Belgians have a chronic kidney pathology, 800,000 suffers from osteoarthritis, between 700 and 800,000 must manage with a rare disease, 700,000 Belgians have chronic bronchopneumopathy while 400,000 are hypothyoridians and 600,000 fight against cancer in treatment. And there are many other diseases.