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August 04, 2020

Preventive medicine: a doctor’s perspective

Prevention Preventive Care

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When I was a practicing physician, talking to my patients about preventive care was one of my favorite things to do. It was also one of the most challenging. In our culture, we see doctors as healers, someone we turn to when we are sick. But did you also know the word “doctor” comes from the Latin word docere, to teach? So, doctors are not only healers, but teachers as well. Of course, teaching involves educating and encouraging patients recovering from illness. But, it also involves teaching people who are well how to prevent illness!

The challenge for all of us is to work hard at protecting our health when we’re not sick. When I would recommend a mammogram, I would often hear, “But I don’t have a history of breast cancer in my family.” When discussing colon cancer screening, patients would ask, “Why would I do that? I don’t feel sick.”

It’s amazing what humans will do to avoid a small amount of discomfort, particularly when there’s no urgency (“I can’t imagine drinking that to clean out my bowels for a colonoscopy!”). But on the other hand, people will go to dramatic lengths to treat a serious illness. Even doing things that are tremendously painful and distressing, such as chemotherapy.

Preventive medicine, a modern concept

Believe it or not, “preventive medicine” is a relatively modern concept. This is not to say that humans haven’t always wondered how to protect themselves from getting sick and dying. But for the most part, doctors and health insurance companies didn’t spend much time actually trying to prevent disease or illness until the 20th century.

If we look back at the beginning of the 20th century, medicine and health looked very different. For example, in 1900, the top three causes of death in the U.S. were all infections: tuberculosis, pneumonia (including influenza), and infectious diarrhea. Fast-forward to 2015: Thanks to better public health measures and antibiotics, infections have been replaced by chronic diseases: heart disease, cancer, and chronic obstructive pulmonary disease (COPD). Stroke is a close fourth.

Three levels of preventive care

We think about preventive medicine on multiple levels:

  1. Primary prevention is trying to prevent an illness or disease from ever starting. An example of this is a vaccination of any type to prevent infections. There’s even a vaccine to prevent cervical cancer, since it is known to be caused by a virus.
  2. Secondary prevention is looking for the disease to find it as early as possible, thus treating and potentially curing it. This includes many cancer screenings, like mammograms, colonoscopies , prostate checks, and Pap tests.
  3. Tertiary prevention aims to soften the impact of a chronic illness that has already been diagnosed and may have lasting effects. The idea is to improve as much as possible in the patient’s ability to function, quality of life, and life expectancy. For example, urging a diabetic patient to have eye exams, kidney monitoring, and good foot care.

Medicare beneficiaries: how to approach preventive cancer screening

Here’s my advice for the Medicare population:

  1. Talk with your doctor. There are many organizations that provide guidelines for when and how often to do screenings, such as the American Cancer Society, American Geriatrics Society, and United States Preventive Services Task Force.
  2. Know what Medicare covers for preventive services. Medicare beneficiaries usually have no coinsurance, copay, or deductible for preventive care services. When it comes to cancer, these include screenings for lung cancer in certain conditions, cervical cancer with human papilloma virus testing, breast cancer, colorectal cancer, and prostate cancer.
  3. Visit the World Cancer Day website and learn about cancer prevention.

Hopefully, the next time your doctor says, “When was the last time you had your mammogram?” or “Looks like you’re due for a colonoscopy,” you’ll be prepared to have a meaningful discussion about the screenings that are best for you.

This article was originally published on IBX Insights.

About Dr. Heidi J. Syropoulos

I joined Independence Blue Cross in 2015 after practicing Geriatrics for nearly 30 years. In my current role I function as the medical liaison to our Government markets team, serving as a subject matter expert on clinical medicine and healthcare delivery. What I love about my new position is the opportunity to help an entire population of people through the benefits of their health plan.

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