preventive medicine?

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barcamdphd21

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I have heard many doctors emphasize the importance of preventive medicine, but with the rising cost of procedures, is it posible to practice preventive medicine? for example, my father suffers GERD and the doctor recomends him to have an endoscopy performed every year. The cost of an endoscopy is roughly $1500

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I have heard many doctors emphasize the importance of preventive medicine, but with the rising cost of procedures, is it posible to practice preventive medicine? for example, my father suffers GERD and the doctor recomends him to have an endoscopy performed every year. The cost of an endoscopy is roughly $1500

Preventative medicine, to me at least, is advising you patients not to smoke, eat too much bacon, and to exercise a lot.

An endoscopy yearly for GERD seems a bit overboard. But having a colonoscopy every few years after you hit 50, is better, both with money and in terms of survival of patients, then waiting till people have full blown colon cancer. The point is, the cost of screening tests, although expensive, is made up in the difference of cost in treating colon cancer that was detected early / slicing a few polyps off vs. treating full-blown colon cancer.

In the same respect it is probably cheaper and easier to have someone on BP and Statin meds then to wait till they need a quadruple bypass.
 
I have heard many doctors emphasize the importance of preventive medicine, but with the rising cost of procedures, is it posible to practice preventive medicine? for example, my father suffers GERD and the doctor recomends him to have an endoscopy performed every year. The cost of an endoscopy is roughly $1500

Your father's doctor is a thief.
 
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I have heard many doctors emphasize the importance of preventive medicine, but with the rising cost of procedures, is it posible to practice preventive medicine? for example, my father suffers GERD and the doctor recomends him to have an endoscopy performed every year. The cost of an endoscopy is roughly $1500

In general, the only indication for regular endoscopy in someone with GERD is in the setting of Barret's metaplasia, a condition which potentially evolves into adenocarcinoma. Theoretically, you can detect adenocarcinoma at an early stage and improve the chances of survival. In this setting, regular endoscopy with survelliance biopsies is performed in a systematic fashion. Should cancer be detected, surgery and possibly adjunctive chemo, would likely be recommended, and patients should know that once they embark on this sort of screening protocol.

Ideally, your father's endoscopist would be able to inform him in some way shape or form what he is paying for, since we have this free market system of healthcare. (ex: "for every 250 patients with Barret's metaplasia whom I scope in a given year, I detect 1 additional early stage cancer that wouldn't have been discovered otherwise")(not an actual representation of real data). If the specialist is unwilling or incapable (by being unfamiliar with the medical literature) of doing so, I'd recommend finding one who can.

Preventive medicine in lay terms often refers to disease screening: early detection of diseases which can be more effectively treated of discovered sooner than later. Most screening tests should increase detection rates AND show a mortality benefit among the population screened. This is the case with mammography and colonoscopy for instance. People who have these studies done over age 50, at certain recommended intervals, statistically live longer than people who don't. Both studies generally are thought to be cost effective. So I would say yes, preventive medicine as you describe it is possible and is occurring all the time.
 
question = Mcanswered.
 
In general, the only indication for regular endoscopy in someone with GERD is in the setting of Barret's metaplasia, a condition which potentially evolves into adenocarcinoma. Theoretically, you can detect adenocarcinoma at an early stage and improve the chances of survival. In this setting, regular endoscopy with survelliance biopsies is performed in a systematic fashion. Should cancer be detected, surgery and possibly adjunctive chemo, would likely be recommended, and patients should know that once they embark on this sort of screening protocol.

Ideally, your father's endoscopist would be able to inform him in some way shape or form what he is paying for, since we have this free market system of healthcare. (ex: "for every 250 patients with Barret's metaplasia whom I scope in a given year, I detect 1 additional early stage cancer that wouldn't have been discovered otherwise")(not an actual representation of real data). If the specialist is unwilling or incapable (by being unfamiliar with the medical literature) of doing so, I'd recommend finding one who can.

Preventive medicine in lay terms often refers to disease screening: early detection of diseases which can be more effectively treated of discovered sooner than later. Most screening tests should increase detection rates AND show a mortality benefit among the population screened. This is the case with mammography and colonoscopy for instance. People who have these studies done over age 50, at certain recommended intervals, statistically live longer than people who don't. Both studies generally are thought to be cost effective. So I would say yes, preventive medicine as you describe it is possible and is occurring all the time.

what? how about promoting knowledge of life style behaviors that my promote or inhibit certain diseases from developing? not just screening so you can start treatment early. the whole point of preventive medicine is that you don't need to know how to treat something in order to PREVENT it.
 
what? how about promoting knowledge of life style behaviors that my promote or inhibit certain diseases from developing? not just screening so you can start treatment early. the whole point of preventive medicine is that you don't need to know how to treat something in order to PREVENT it.

I would hardly say that the whole point of preventative medicine is that you don't need to know how to treat something to prevent it. Preventative medicine is as much about early intervention as it is about true prevention.
 
I would hardly say that the whole point of preventative medicine is that you don't need to know how to treat something to prevent it. Preventative medicine is as much about early intervention as it is about true prevention.


arguable. i'm not saying that once the patient has early signs of the disease, preventive medicine is out the window. but avoiding disease all together and promoting proper health and proper health behaviors is the key

From the American Board of Preventive Medicine

http://www.abprevmed.org/aboutus.cfm

"Preventive Medicine is the specialty of medical practice that focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death."

no where does it say the goal is to "treat early signs of illness once a patient has been diagnosed with a disease"
 
no where does it say the goal is to "treat early signs of illness once a patient has been diagnosed with a disease"

I think that would fall under "Prevent Death". Either way, this debate is purely academic. It doesn't matter whether we call it preventative medicine or actual medicine, what is done doesn't change.
 
I think that would fall under "Prevent Death". Either way, this debate is purely academic. It doesn't matter whether we call it preventative medicine or actual medicine, what is done doesn't change.

what are your referring to?
 
what are your referring to?

Disease screening (mammograms, colonoscopy ex.), vaccinations and education about healthy living. Calling it preventative medicine or not won't effect the actual practice of it. We are going to do it regardless of what distinction we give it.
 
I have heard many doctors emphasize the importance of preventive medicine, but with the rising cost of procedures, is it posible to practice preventive medicine? for example, my father suffers GERD and the doctor recomends him to have an endoscopy performed every year. The cost of an endoscopy is roughly $1500

Mcdoctor beat me to it but I would guess that your dad has barrett's metaplasia- where the normal stratified squamous cells of the esophagus turn into columnar cells.
 
As a physician assistant and self proclaimed public health sociologist I can say with confidence from what I have studied and witnessed that the greatest preventive medicine strategy will address the foundation social and behavioral conditions which create close to 60% of premature deaths in the United States and create a huge cost burden. Additionally we need to address the insurance crisis. We need to provide full coverage, and at the very least some opportunity for prevention in those 40 million without. These suggestions make sound economic and moral sense. If you would like to discuss any of my ideas at length please send me a private message.
 
what? how about promoting knowledge of life style behaviors that my promote or inhibit certain diseases from developing? not just screening so you can start treatment early. the whole point of preventive medicine is that you don't need to know how to treat something in order to PREVENT it.

You actually highlighted that I said "...in lay terms often refers to..." which clearly means I wasn't stating a "textbook" definition of preventive medicine. (That would have been pretty lame, actually). The OP framed the question in the context of whether or not screening for GI cancer, and disease screening in general, was effective or appropriate or even worth doing from a general health standpoint. He/she used the term preventive medicine and disease screening somewhat interchangably, so i did the same.
 
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