They have a “if it ain’t broke, don’t fix it” mentality.
Related posts:
- The numbers behind young, healthy people dying from H1N1 flu
- Pay primary care by the hour, again
- Angioplasty in a healthy patient, and why preventive heart care is dismissed
- Dean Ornish talks primary care
- UnitedHealth: "The health care system isn’t healthy"
- Free = more utilization
- You Too Could Be as Healthy as a Salmon!
KevinMD.com on Facebook
{ 8 comments }
This is the correct attitude for all, not just the young. Until there is an actual health problem, there is not a lot the health care system can do to benefit the well.
Cancer screenings for those without particular risk factors are of minimal value. Query once for history for risk factors when the patient is 30ish and one can then pass on screenings for the next couple decades. For heart disease, again genes and family history count for much. No risk factors and a normal lipid profile in your 30s and send them away with the reminder to eat right (food, not packaged stuff, not too much, mostly plants), and exercise regularly. If they aren’t fat then screening for diabetes, hypertension and other such chronic conditions is of limited value also.
Medicine still cannot vanquish your genes. Not knowning what will kill you is no worse off in most instances than knowing what is going to kill you (and knowning that there’s little to do about it anyway).
Preventative health care does not stand up to outcomes based evidences.
But, but, but…. I thought that preventive care was supposed to lead us to the promised land.
The patient in the article hadn’t seen a doc in 4 years. I havn’t seen as doc myself since I last turned my had and coughed at age 17 (not an exam quickly forgotten by an adolescent male). That’s now been 25 years and counting. My 92 year old grandmother keeps the same attitude regarding preventative health care. Someday when she feels the need she might go see a physician; but even then what could possibly be offered?
“Preventative health care does not stand up to outcomes based evidences. ”
As far as I know, mammography, psa, and pap smears are all well established in efficacy at decreasing mortality (has this changed recently???)
Also, how much alcoholism and depression are picked up in a primary care docs office for a preventive visit? This we’ll never know – we only hear of the cases that make news because of tragic outcomes.
If primary care can’t sell it’s own utility to other DOCTORS, we definitely are in for a grave future in healthcare, especially as the population ages.
As far as I know, mammography, psa, and pap smears are all well established in efficacy at decreasing mortality (has this changed recently???)
1. There is no evidence that PSA decreases mortality from prostate cancer. If you have it, would you care to show it to us?
2. The mortality reduction shown in studies for mammography (not sure about pap smears) is desease-specific mortality. Nobody has ever shown all-cause mortality reduction for screening. Yes, I understand it is difficult to show it given a small fractions deaths from specific condition represent among all deaths, but it is still important to keep the fact in mind.
3. While the relative (desease-specific) mortality reduction is statistically significant, the probability of an individual benefitting is extremely small. This is true for all screening tests.
4. The mortality benefit comes at a price. For every woman whose life is saved by, for example, mammograms, several women may get diagnosed with breast cancer unnecessarily. Overdiagnosis leads to overtreatment and overtreatment may cause problems. A lot more women will have false positives and biopsies.
5. During preventive care visits doctors often order non-recommended tests. Tests lead to false positives, overdiagnosis, and cost money. False positives lead to more invasive tests, those have risks of its own.
There is a case to be made for preventive care; but there is a case against it as well. It is up to an individual to decide.
1- that is absolutely true (my bad; sorry)
2- reduction in breast-cancer-related mortality with mammograms, i submit, is still beneficial, even if overall mortality is not affected. I understand how one might disagree, however.
3- even if the probability of picking up a curable breast cancer in an asymptomatic 55yr-old is 1/5000 (i’m guessing at the numbers) i think many docs and patients feel this is worthwhile
4- point taken. this will be especially true if screening hi-res lung ct scans (for smokers) become more commonplace.
5- i agree. overdiagnosis is especially troubling in the elderly, where NOT knowing a patient has a terminal illness is often easier, cheaper, and more humane. This becomes complicated in today’s era of increased patient and family involvement in even the smallest details of evaluation & treatment.
Preventive care is indeed a personal decision, but does leaving too much to patients cause other problems (e.g. Merenstein)?
All the hoopla about universal coverage threatens to force people to pay for something that many dont’ want: comprehensive health care. Even if you pay people to see a doctor regularly, many just don’t want to.
I don’t blame them. It is fine for sick people. But the people who live to remarkable ages didn’t get that way by handing around doctor’s offices. After two negative breast biopsies (and no breast CA in the family) my wife has decided no more mamograms. She would rather forgo the reduction(not elimination) in risk of fatal breast CA than the higher risk of more negative biopsies.
My great grandmother lived to 100 and never saw a doc before the last few years of her life (midwife deliveries).
Health care is a personal option, not the public’s business, and people should be free to seek it or not, pay for it in advance or take their chances. Either way, we all die in the end, insured or not.
Preventive care is indeed a personal decision, but does leaving too much to patients cause other problems (e.g. Merenstein)?
Merenstein is about a lawsuit. Since this thread is about going vs not going to a doctor for preventive care this is not relevant to this discussion. If you don’t see a doctor you have nobody to sue.
For the record, while most women in the US would choose mammograms given the (largely overestimated by most US women) probability that their life will be saved, it is perfectly fine for a woman to choose not to do it. It is a trade-off of what is more important for each woman – a small (1/500 to 1/2000 depending on one’s age and interpretation of the studies) and arguably larger (but still small) chance of unnecessary potentially harmful treatment and a much larger chance of biopsies.
The same could be said about all preventive care. It is not an obligation, it is not what “responsible people do”, it is personal choice. As long as one’s health decisions don’t seriously impact health of others, we have a right to make them.
Comments on this entry are closed.