Prevention: Oversold and Undersold…

March 19th, 2009 at 02:55pm Dr. Martin Lipsky

After listening to President Obama’s speech to Congress, it appears that we will all be hearing more about prevention as a way of improving health and lowering health care costs. As a primary care physician, I embrace prevention but do wonder if both physicians and patient expectations are realistic? In some ways prevention may be both oversold and undersold. Dr. Alfred Berg, a former head of the U.S. Preventive Services Task Force, says, “We need to look at the data carefully so we do things that make sense and use our resources wisely.”

For example, many women regularly see their physicians to get an annual mammogram. While recommended, women tend to overate their risk from breast cancer and vastly underrate their risk from heart disease, which is by far the leading cause of death among woman, or from the flu, which kills many women each year. The point is that sometimes very effective interventions such as influenza vaccinations and smoking cessation can be overlooked. This is one reason that I feel it is so important to have a personal doctor who can discuss these issues with you and to tailor preventive recommendations. In addition, by taking a good medical history, learning about your family history and conducting a thorough examination, your doctor might make recommendations for you that would not be suitable for someone else.

A common preventive visit for a woman is for a pap smear. During that visit, I strongly encourage a woman to ask her doctor what other type of preventive measures he or she can recommend and what is their philosophy about prevention. I asked one of our obstetrician/gynecologist specialists, Dr. Teddy Bachawaty how he approaches prevention during an annual exam.

He said, “While most women are coming to see me for a cancer check up, I feel that the visit is a valuable opportunity for me to discuss other recommended preventive measures for someone in the patient’s age group. To guide me in this discussion, I use recommendations from the United States Preventive Services Task Force (www.ahrq.gov/clinic/uspstfix.htm) and those made by my specialty society, the American College of Obstetrics and Gynecology. If the patient has her own primary care physician it gives me a chance to either reinforce their recommendations or to encourage the patient to make an appointment. For a woman who wants comprehensive care from me, I consider four general areas including immunizations, cancer prevention, cardiovascular disease and chemoprophylaxis. Chemoprophylaxis is the use of medication to prevent disease or infection.

For example, during a preventive health care visit, I make sure that my patients are up to date on their vaccinations – including an annual flu shot. For cancer screening, in addition to a Pap smear, I arrange for a mammogram or colon cancer screening if indicated. Cardiovascular disease is the leading cause of death for woman so I check blood pressure, see if the patient has had a recent lipid profile, check the body mass index and counsel about maintaining a health lifestyle. Many people may overlook chemoprevention, but making sure that a patient is getting adequate calcium and supplementation, if needed, is critically important. However, the thing I really like to do is work with my patients to tailor their recommendations to their personal health, their personal risk factors and to partner with them if they need to make life style changes. Like all of us, I know how hard it is to always eat right and get plenty of exercise, especially since I have a new baby at home.”

I think Teddy has an approach similar to mine and one that I think builds better health in the long run. If any woman has questions about preventive issues, please feel free to e-mail Dr. Bachawaty at bachawat@uic.edu or contact Women’s and Children’s Health Center at 815.637.0000 to schedule an appointment.

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