I started medical school in my 30’s, so I have some experience seeing life through the eyes of a non-physician adult. I’m now thoroughly socialized as a doctor, but I do have flashes of memory from my pre-indoctination days.
Recently I was reading a journal article on how a fabulous new pharmaceutical product (we’ll call it Fabulotor) can help control your fabuloglobin levels, which are much too high in most Americans and lead to unspeakably horrible diseases which shift patient billing from your primary care doctor (me!) to your surgeon (boo!). Like most such studies it concludes with the statistic that we’d only have to give Fabulotor to 500 patients (for the rest of their lives) to prevent one death. So 500 is the “number needed to treat,” a generally accepted metric for the worth of any preventive measure.
Did you get that? When medical doctors talk about “prevention,” they mean things like (1) identifying an abnormal lab value and (2) giving you a pill to take every day in perpetuity. And not to prevent your death, but to prevent one death for every 500 of you that we treat.
It occurred to me that, before I was a doctor, I wouldn’t have called such a thing “preventive medicine.” But that is, in fact, what most doctors are taught to think of as prevention. (Oh, yes, and reminding patients as they’re walking out the door to always eat healthy, exercise, and stop smoking.)
Preventive care needs to start with changes to the way we eat, the kind of physical activity we do, and our health-hostile choices. Remarkably, though changes don’t need to be radical or involve a lot of pain and deprivation. They might require a (surprisingly small) effort, but way less than your health is worth. I’m going to try to shift to that emphasis in my practice. That is, after all, why we’ve structured the practice so that we only see two patients per hour. It isn’t the sort of thing you can do in a seven minute visit.
But don’t worry if you’d rather keep eating fast food, avoiding walking, and overindulging. I’ll happily prescribe Fabulotor and a half-dozen of its cousins for your hypertension, erectile dysfunction, diabetes, obesity, cancer, and heart disease when they occur.
–DrR