Introduction

Reviews

Is Your Doctor Practicing Good Preventive Medicine?

Timothy B. McCall, M.D.

Here are statistics on the top causes of death in this country. Most of them, it turns out, are preventable. In spite of all the highly-publicized cures, most of the time all doctors can do is treat symptoms and sometimes keep the inevitable in check for a while. That’s why prevention is so important.

The Top Ten Causes of Death in the United States, 1990
Cause of Death	Number of Deaths	% of Total
Heart Disease	720,000	33.5%
Cancer	505,000	23.5%
Strokes	144,000	6.7%
Accidents, e.g. car crashes	92,000	4.3%
Chronic Lung Disease	87,000	4.1%
Pneumonia and Influenza	80,000	3.7%
Diabetes	48,000	2.2%
Suicide	31,000	1.4%
Liver Disease, e.g. cirrhosis	26,000	1.2%
AIDS and HIV infection	25,000	1.2%

Prevention doesn’t have the cachet of something like balloon angioplasty, which when it works can result in dramatic improvements. When a cardiologist navigates a tortuous coronary artery with the catheter and blows up the balloon to obliterate a blockage in an artery, the patient’s symptoms may be relieved instantaneously. A heart attack may be averted. It’s not uncommon for applause to break out in the cath lab after a doctor successfully completes a difficult maneuver. The skilled cardiologist revels in adulation from patients, nurses and colleagues.

A spectacular cure is a lot sexier than preventing that illness in the first place, especially if the illness was prevented with talk. No one slaps you on the back to say “Great job, getting that guy to quit smoking.” But in many patients who undergo angioplasty, if a doctor had spent five minutes—and sometimes that’s all it takes—convincing them to quit smoking or to start exercising, their angioplasties would never have been necessary. A doctor, though, can never be sure when a preventive effort has paid off. When something bad does not happen, it is impossible to prove it would have if you had not intervened.

Prevention is among the most important duties of a physician. Many practicing physicians largely ignore it, however, focusing instead on diagnosis and treatment. These doctors act as if prevention and their traditional duties were mutually exclusive. Office visits, in fact, present the perfect opportunity to practice preventive medicine, especially if the doctor and patient have established a relationship of confidence and trust. More importantly, if prevention isn’t incorporated into routine care, it may never happen since many people only go to the doctor when they’re sick.

Of all the preventive measures at a doctor’s disposal, the ability to counsel people to change unhealthy habits is probably the most powerful. The reason is that the real power to prevent disease lies with patients, not doctors. The way you live profoundly affects your chance of getting certain diseases.

Physicians should therefore be educating their patients about proper diet and exercise. The typical American eats too many calories, too much fat, too much salt and not enough fiber. High fat diets are linked to heart attacks, diabetes and cancer. Regular exercise is known to reduce stress, boost the immune system, lower the risk of a heart attack and strengthen bones. Just 20 minutes of walking three times a week can bring benefits.

Good doctors take the time to take about your lifestyle and how it can affect your health and in a non-judgmental way offer suggestions.

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