The past decade has seen remarkable advances in our ability to prevent disease or disease progresion. We can decrease the probability of coronary artery disease, congestive heart failure, diabetes mellitus, colon cancer, skin cancer, etc. We can treat patients with those diseases and retard progression. Yet we only do a mediocre job. As I consider various posts since starting this blog, several common themes relate to prevention:

• The cost of preventive medications


• Conflicting data on whether a preventive measure works


• Physician's inconsistency in prescribing preventive measure


• Patient's reluctance to accept screening tests


• Risk benefit ratios change as new studies are published

Physician time pressures have negative effects on patient care. Prevention often takes time. One cannot just write a prescription for exercise or diet, and expect excellent results. These issues take exploration, reinforcement, and questioning. Physicians don't have the time to do this right. We aren't trained that well in behavioral modification, and generally don't develop those skills. Our time pressures also decrease our ability to remember the increasing list of prevention issues. If you only have 15-20 minutes per patient, some issues cannot have full exploration.

Finally, we have conflicting recommendations. Specialty societies often develop guidelines based on their beliefs, rather than objective data. When independent groups develop alternate guidelines, physician confusion reigns. At what age should I start ordering mammograms, or PSAs? Is an annual rectal examination worthwhile? Which patients with hypercholesterolemia deserve treatment?

I hope medical leaders will address these issues. Interesting that most things generally boil down to time and money. Regardless, continue to consider prevention. Try to develop your system to maximize your patient's future health.