Wednesday, July 20, 2011

Preventative Health: Is it Really Preventative?

Lately, there has been increased emphasis on "preventative" care in the US now that there are some mandates under the Affordable Care Act. There is even the U.S. Preventative Services Task Force (USPSTF) which is a panel of private sector experts who recommend evidence based preventative screenings for certain conditions based on factors such as age and gender.

As a family nurse practitioner, I base a large part of my practice on wellness and prevention in addition to episodic (or "sick") care. I believe in "wholistic" care - that is, care of the whole person including mental and physical states. Though lately, I question whether if "preventative" is really the best moniker for this type of care. Prevention assumes that one can completely avoid health conditions by subscribing to certain recommendations, screenings and/or tests. Is it naive or even obnoxious to think that we can prevent disease and illness? I have seen many patients follow all the recommendations only to end up with some other life threatening malady. Of course, we cannot avoid all sickness and illness as there are inherent non-modifiable risk factors (such as age, gender and heredity) that hold the potential to affect one's health. 

I am not necessarily disputing any evidence or recommendations that have been introduced but the false sense that we have the ability to "prevent" an illness or disease from happening in the first place. This can lead to unrealistic expectations and negative backlash. Yes, we be able to detect an early cancer prior to it's spread or immunize individuals against certain infectious diseases. But prevent altogether? Sadly, I don't think so - in fact, I know so. 

That's why I am using the term pro-active health rather than prevention. There are actions that individuals can take to lower their risks from disease and illness and I believe that is taking a pro-active part in one's health. We do this in the hopes of longevity, wellness, disease avoidance and early detection (if illness is identified).

Perhaps I am more hung up on terminology in my new post doctoral reflective state. I believe in open and transparent communication with my patients and other members of the care team. I don't want to purport to my patients that we can cure and prevent all illness. We can however, instill evidence based methods to increase patient activation, patient engagement, and ownership of one's health and behaviors to take a pro-active approach and present realistic expectations based on the available data. 

I'm curious to know what you think. Am I too fixated on the words (and the resulting expectations from that title) or are we possibly setting patients up for let-down and failure if they do encounter illness after following all recommendations? Please feel free to comment below.


Lynda Halliger-Otvos said...

Steve, it seems like semantics to me. What ever we call it, I hope we can get the populous on board with the idea of better weight control and exercise for cardio. I have lost both my younger sibs in the past three years and they were under 50; one PE and one MI. Unbelievably emotionally wrenching--like nothing else in life so far for me. Anything we can do to help wipe out heart disease is good.

Thinkingdoc said...

Very relevant post.I mostly agree. It is important that we truly understand risk/benefit of screening-case in point is PSA testing where,IMHO,we often harm. Screening is not w/o costs and it is often not clear cut.Of course, we will talk about healthy living,but we will offer best treatments and support when illness comes, as it will for all of us. Thanks for articulating all this.

Barefootnurse said...

I also tend to agree with your position and would add that there is a certain level of personal responsibility on the part of the patient. We can educate and provide the information, we connect them to the right resources and help them make the take the right steps towards preventing a lot of conditions. Having said that, there are still many illnesses and diseases that just happen that are not preventable, so perhaps our focus then becomes managing symptoms or preventing further progression.

Halie (Srcubs Editor) said...

Very timely, and I'm totally with you "pro-active health" is much more apropos.

Donald Kjellberg said...

Preventive care is sometimes completely relevant. Smoking for 30 years, not eating healthy foods or exercising, then coming in with CHF is really avoidable and appalling in my mind. Patients who are competent are completely responsible for their own health in as much as conditions such as these can be avoided. I believe you are speaking to variables that do not fall under the classification of primary prevention and as such, proactive is more appropriate. Both elements should be considered when approaching treatment. You are right there is a distinction and more discussion is necessary.

Anonymous said...

I am a Nephrology Nurse Practitioner, and teach treatment option classes, dietary management of renal disease, blood-pressure control, diabetic name it, in an effort to reduce the risk of ESRD and dialysis. I like the idea of preventative medicine, but have yet to see it work in my population. Just this week Medscape Nephrology offered a discussion by Dr Jefffrey Burns, that reinforced that preventative medicine in renal disease might be of little value. Every body can benefit from healthy living, and it starts in childhood. Prevent obesity, in my opinion the root off all evil in medicine and the management there off is practically impossible when the patient have been struggling with it their entire adult life. Interesting and thought provoking blog. One more way to cut cost, next to avoiding unnecessary blood work (treating numbers) and supplying durable medical equipment (electric wheel chairs ) to morbid obese patients.