JOURNAL 4

1. What have I learned this week and how can it help me become a 5-star physician?
This week, I have attended webinars such as primary care approach to allergy,
lectures on hypertension, erectile dysfunction and real world data on nebivolol. I appreciated
this topic since it was a part of the clinical dilemma we presented and the topic for our
journal review.
What kept me busy this week was doing my video presentation for chest physical
examination which involved a lot of time to work on setting up, filming and especially
editing. Since I am living in my boarding house and patient for my presentation is not
readily available, I had to ask my co-intern to be my patient, and in return I had to look for a
patient for him to demo it with since it would be ideal for or video presentation if it was a
male patient.
Family medicine rotation had given me an opportunity to learn from diverse ways
and appreciate what we are doing. It is not only technical or always by the books, yet most
are, but being a student doctor I learned that every time we put ourselves out there, it is not
only our minds or knowledge as a doctor we impart to our patients but also our character as
a person. In order for us to really show a patient our care, it is valuable to let them see that
we somehow feel or experience what they are having too. Because being a 5-star doctor, as a
care-provider, we must take into account the total physical, social and mental needs of our
patient.
Being taught about the different levels of disease prevention is essential in
knowing which type of care, plan or management we are going to do when the patient’s is at
a certain level. We always say that prevention is better than cure, and as my mother always
say, I think the most ideal way to avoid catching or having a disease is at primordial or
primary level where we take precautionary measures before the development of a risk factor
that would soon lead to the disease. Health education has a vital role in every level of
disease prevention, and as I have said in my previous journal, health care is a two-way
process which involves me as the provider and my patient as the receiver, and an active
participation from my patient should be encouraged in order for the plan of management to
work and the progress could be seen. In order to be a 5-star physician, we need to be a good
communicator.
 Periodic health examination gives a high importance to cost-effectiveness and
scientific evidence to the selection of examination in preventive care from primary to
tertiary level. It includes screening, counselling, chemoprophylaxis and vaccination.
Determining the risk factors of a patient is an important way to assess a patient’s condition
which must involve his medical history, family history, sexual history, lifestyle, stressors &
coping mechanisms and support system. To be an efficient 5-star doctor, one needs to be a
good decision maker.
2. Comprehensive Wellness Plan for direct family members
a. Shellane Divina (Mother), 53y/o, government employee, widowed, with a history of type
2 diabetes mellitus, diagnosed 12 years ago, maintained on linagliptin (tradjenta),
recently she was hypertensive and maintained on carvedilol (carvid). Her identified risk
factors are sedentary lifestyle, loves drinking carbonated drinks and she is overweight.
Lifestyle Counselling:
- Dietary prescription of increased fruits and vegetables
- Exercise prescription
- Encourage her to avoid or minimize drinking carbonated drinks
Screening Tests:
- FBS, lipid profile
- HbA1c after 2 to 3 months
- Urinalysis for early detection of kidney complications
- Comprehensive ophthalmological exam to check for retinopathy
- FOBT because he is 50 years old and for colonic cancer check
- Recommend Pap smear every 3 years
Vaccination:
- Influenza and pneumonia vaccine
- HPV vaccine
- Tetanus booster if no previous vaccination for the past 10 years
Chemoprevention:
- Sangobion
- Calcium caltrate
- Selenium
b. Rashell Anne (Me), 25y/o, medical intern, single with no known medical history but with
a history of knee dislocation last July, 2018 due to an accident. My known risk factors
would be overweight, sedentary lifestyle, family history of diabetes, hypertension and
breast cancer.
Lifestyle Counselling:
- Dietary prescription of increased fruits and vegetables to include high fiber diet
- Exercise prescription with precaution on right knee
Screening Tests:
- FBS, lipid profile
- Monthly digital breast examination
Vaccination:
- Influenza and pneumonia vaccine
- HPV vaccine
- Tetanus booster if no previous vaccination for the past 10 years
- Hepatitis B vaccine
- Meningococcal vaccine
Chemoprevention:
- Multivitamins + Iron
- Calcium caltrate
- Selenium
c. Christine Joy (sister), 19 y/o, college student, single with no known illness and is
physically fit. Risk factors include her family history of diabetes, hypertension and breast
cancer.
Lifestyle Counselling:
- Dietary prescription is maintained on fruits, vegetables, high fiber diet and low
carbohydrate intake
- Exercise prescription is maintained
Screening Tests:
- FBS, lipid profile
- Monthly digital breast examination
Vaccination:
 - Influenza vaccine
- HPV vaccine
- Tetanus booster if no previous vaccination for the past 10 years
- Hepatitis B vaccine
Chemoprevention:
- Multivitamins + Iron
d. Alwin Dominick (brother) 17 y/o, senior high school student, single, with no known
medical history or present illness. His risk factors are overweight and family history of
diabetes and hypertension.
Lifestyle Counselling:
- Dietary prescription is maintained on fruits, vegetables, high fiber diet and low
carbohydrate intake
- Exercise prescription
Screening Tests:
- FBS, lipid profile
Vaccination:
- Influenza vaccine
- Tetanus booster if no previous vaccination for the past 10 years
Chemoprevention:
- Multivitamins + Iron