Lately, there has been increased emphasis on “preventative” care in the US now that there are some mandates under the Affordable Care Act. The U.S. Preventative Services Task Force (USPSTF) exists, which is a panel of private sector experts who recommend evidence-based preventative screenings for certain conditions based on factors such as age and gender.
As a family nurse practitioner, I base a large part of my practice on wellness and prevention in addition to episodic (or “sick”) care. I believe in “wholistic” care – that is, care of the whole person including mental and physical states. However, I question whether if “preventative” is really the best moniker for this type of care. Prevention assumes that one can completely avoid health conditions by subscribing to certain recommendations, screenings and/or tests. Is it naive or even obnoxious to think that we can prevent disease and illness? I have seen many patients follow all the recommendations only to end up with some other life-threatening malady. Of course, we cannot avoid all sickness and illness as there are inherent non-modifiable risk factors (such as age, gender and heredity) that hold the potential to affect one’s health.
I am not necessarily disputing any evidence or recommendations that have been introduced, but the false sense that we have the ability to “prevent” an illness or disease from happening in the first place. This can lead to unrealistic expectations and negative backlash. Yes, we may be able to detect an early cancer prior to it’s spread or immunize individuals against certain infectious diseases. But prevent altogether? Sadly, I don’t think so – in fact, I know so.
That is why I am using the term pro-active health rather than prevention. There are actions that individuals can take to lower their risks from disease and illness and I believe that is taking a pro-active part in one’s health. We do this in the hopes of longevity, wellness, disease avoidance and early detection (if illness is identified).
Perhaps, I am more hung up on terminology. Since communication is paramount in patient care, I believe it should be open and transparent with my patients and other members of the care team. I do not want to purport to my patients that we can completely cure and prevent all illnesses. We can however, instill evidence based methods to increase patient activation, patient engagement, and ownership of one’s health and behaviors to take a pro-active approach and present realistic expectations based on the best available evidence.
Stephen A. Ferrara is a family nurse practitioner who blogs at A Nurse Practitioner’s View.
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