I belive in a thing called....uh preventative medicine

[lonewolf1513]

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Hey guys sorry for the tons of post, but i finally had off from work 🙂. So here it goes, i work in a pharmacy and all i see is people taking pills ( i know its a pharmacy, what do you expect). The sad part is i see it outside all the time as well, my parents, friends, etc... It seems like we are obsessed with the shortcuts. As a future physician to be (god willing), i was wondering how current practicing physicians talk their patients into taking better steps to a healthier life.

 

[Drrrrrr. Celty]

Hey guys sorry for the tons of post, but i finally had off from work 🙂. So here it goes, i work in a pharmacy and all i see is people taking pills ( i know its a pharmacy, what do you expect). The sad part is i see it outside all the time as well, my parents, friends, etc... It seems like we are obsessed with the shortcuts. As a future physician to be (god willing), i was wondering how current practicing physicians talk their patients into taking better steps to a healthier life.

im not a physician buttt..... 😀😀😀
i'd just say this..
get off you ass... do some curls and run for about 30 minutes a day.. cut trans-fat out of your diet, learn about nutrition, take a mutli-vitaman everyday ( yes its a pill but come on lol).
Either way, it doesnt matter half of the people will find it a bit hard to change there lives and as such will basically go back to sitting on a coach and soaking in fatty foods.
EX. myself lol.. except my diet is good, i just need to get off SDN and go to the gym haha >,<

 

[beckhunter116]

Well in a perfect world we would have the time to educate people on changing lifestyles vs. the ease of popping a pill. Unfortunately, I think you have to choose your battles and try to incorporate the most into the 15min window you have with a PCP. As a specialist, you may have a longer window to talk more with your patients. I'm not sure how those offices typically work as I've only shadowed an EM, FP, and Anes.

 

[beckhunter116]

im not a physician buttt..... 😀😀😀
i'd just say this..
get off you ass... do some curls and run for about 30 minutes a day.. cut trans-fat out of your diet, learn about nutrition, take a mutli-vitaman everyday ( yes its a pill but come on lol).
Either way, it doesnt matter half of the people will find it a bit hard to change there lives and as such will basically go back to sitting on a coach and soaking in fatty foods.
EX. myself lol.. except my diet is good, i just need to get off SDN and go to the gym haha >,<

You have the bedside manner of an angel. I'm sure patients will flock to you by the herd. HA HA, herd since you think all overweight people are lazy cows, right?

 

[JaggerPlate]

Preventative medicine is so essential and could honestly fix a lot of stress we have on the current system. Here's the problem ... you have an overweight male who is in his current predicament because he sits around eating all day, watching TV. Now, he has diabetes and joint pain ... you tell him he can either exercise, eat right, and get up off the couch ... or he can pop pills for both ailments. What do you think he's going to choose? It's a shame, but it is a reality. Frankly, I think there is a place for preventative care, but I would honestly build up a patient load from people who actually want it as well. The upside is that there are lots of docs/hospitals, etc, that will just push the pills and people can still seek these services.

 

[cardiackid88]

Preventative medicine is good, maintaining a normal/healthy lifestyle. But sometimes pills/medicines are necessities. Take H1N1: ideally you could have everyone wearing masks, carrying around Purell; but I seriously doubt children will strictly follow anything (you see them putting dirt in their mouths, and if you've taken Micro...lol the Pseudomonas). People pop pills as dietary supplements, pre/pro-biotics, vitamins, medicine, etc. Could you specify what "pills" you see people taking? Unnecessary pills (those diet pills on ads, viagra/enzyte, whatever), I agree with you.
Physicians can recommend the best plan possible for each individual patient, but it's a 2-way street. If you've got a willing patient, that's great; if not, as serenade put it, you can't really change anyone's habits if they're accustomed to them. If you've volunteered in the hospital, you should know about patients who are smokers. If they don't get their cigs, they turn quite angry and dissatisfied w/ their care. Some hospitals may even have nursing floors that allow patients to have a smoke outside (as "allowed by their physician").
I like your belief in preventative medicine, but sometimes the reality of the situation has to take over. As beckhunter116 said, "choose your battles." A physician needs to give their best recommendation/guidance/friendly advice and hope the patient is receptive.

 

[beckhunter116]

Preventative medicine is so essential and could honestly fix a lot of stress we have on the current system. Here's the problem ... you have an overweight male who is in his current predicament because he sits around eating all day, watching TV. Now, he has diabetes and joint pain ... you tell him he can either exercise, eat right, and get up off the couch ... or he can pop pills for both ailments. What do you think he's going to choose? It's a shame, but it is a reality. Frankly, I think there is a place for preventative care, but I would honestly build up a patient load from people who actually want it as well. The upside is that there are lots of docs/hospitals, etc, that will just push the pills and people can still seek these services.

I agree that we should counsel patients on the importance of a healthy life and discuss some simple ways to live healthier, but a lot of factors go into obesity/overweight issues. There was an article in Time based on a Cleveland Clinic (I think, I can't find the article now) study on how exercise really wasn't helpful in losing weight.

For the highlighted comments, yeah I'm sure we have all seen the TLC shows of the 650lb man or half ton teen, etc...I don't think we can claim that all over-weight people are lazy or eat McD's for every meal...could they eat better? Sure. Could they plan their day better? Yeah.

To be honest the only reason I get worked up about this is because this isn't as much of a cut and dry issue as some make it out to be. Also, there are plenty of choices that our patients could make that would bother us, but people always love to jump on the bandwagon of fat=lazy. Whenever a thread like this appears it's usually over weight issues (I agree that it is a major problem in America), but no one brings up counseling patients about safe-sex practices although STDs and teen pregnancy run rampant, no one encourages therapy over zoloft, or that a major reason people don't get paps, mammo, colonoscopy, and etc is because they are frightened of these experiences and their physician never educates them on this issue and talks them through it... so my point is there are a lot of areas for preventative medicine that could be discussed but we never seem to get to those ideas.

 

[JaggerPlate]

beck ... I'm sorry if I offended you or anyone else. I was simply stereotyping to make a point. I definitely understand that no issue is cut and dry, I was simply trying to point out some of the problems with preventative medicine for the 'general' population.

 

[beckhunter116]

beck ... I'm sorry if I offended you or anyone else. I was simply stereotyping to make a point. I definitely understand that no issue is cut and dry, I was simply trying to point out some of the problems with preventative medicine for the 'general' population.

Jagger, I wasn't offended or anything...I may have come off a little strong, I just wish when these threads came up that we talked about more than just exercising/dieting/weight issues when there are a lot of other issues that could be addressed but don't seem to be.

 

[Cybii]

Hey guys sorry for the tons of post, but i finally had off from work 🙂. So here it goes, i work in a pharmacy and all i see is people taking pills ( i know its a pharmacy, what do you expect). The sad part is i see it outside all the time as well, my parents, friends, etc... It seems like we are obsessed with the shortcuts. As a future physician to be (god willing), i was wondering how current practicing physicians talk their patients into taking better steps to a healthier life.

The second DO I shadowed laid on the guilt-trip SO HARD one time on a patient she started to cry, he was that good. He did the classic, "don't you want to be there for your grandchildren? be a supportive wife for many more years? you're missing out so much from life by supporting this lifestyle" etc etc and once the patient started to cry and was agreeing with him, he finished up with "here is your new diet. here are your rules and resources to stop smoking." 😎 classic.

 

[beckhunter116]

The second DO I shadowed laid on the guilt-trip SO HARD one time on a patient she started to cry, he was that good. He did the classic, "don't you want to be there for your grandchildren? be a supportive wife for many more years? you're missing out so much from life by supporting this lifestyle" etc etc and once the patient started to cry and was agreeing with him, he finished up with "here is your new diet. here are your rules and resources to stop smoking." 😎 classic.

I'm glad that he actually gave the patient the tools to change. I've shadowed doctors that literally said lose weight and quit smoking, but never addressed the tools or even suggested things like weight watchers to give the patient an idea of where to start.

 

[Daedra22]

What astounds me is that with all this focus on diet and nutrition and "being healthy" on the news, a whole lot of people still don't get it. I work as a delivery driver, and I answered this call last week...

"Yeah, I want a pizza with everything, and then something healthy... like with alfredo sauce. Do you have alfredo?"

"Um... yes we do... but are you aware that alfredo sauce has FAR more calories than the regular pizza sauce?"

"Really? Wow, I had no idea..."

Alfredo sauce... which is made with butter and cream... better than marinara sauce that is made with tomatoes? Seriously, how could you not know...? And aside from that, why are you ordering pizza if you want something healthy?

When things like this happen, I wish that health professionals were better about communicating with patients. I'm not sure what it will take, but surely we can find some way to get the word out.

 

[cardiackid88]

I'm glad there are now shows on TV trying to show physicians caring for the general public. Have you seen The Doctors or Dr. Oz? Pretty informative stuff. I think Dr. Oz scares more people into a healthier lifestyle by showing their weight, body fat, cholesterol, blood pressure, and "real age." However, I think Jillian from The Biggest Loser can overdo it sometimes when trying to educate the public. I remember her on The Doctors for their Thanksgiving episode. I got sick of her (instead of getting sick of looking at all the food and potential calories presented) because she kept on asking "who would eat that?" and other stuff that takes away the spirit of the Thanksgiving feast. Sometimes it's the way the physician (or another type of adviser) presents the information in a patient-friendly manner that can influence people's attitudes.

 

[beckhunter116]

Alfredo sauce... which is made with butter and cream... better than marinara sauce that is made with tomatoes? Seriously, how could you not know...? And aside from that, why are you ordering pizza if you want something healthy?

When things like this happen, I wish that health professionals were better about communicating with patients. I'm not sure what it will take, but surely we can find some way to get the word out.

LOL, ahhh the gene pool that is swimming out there...makes me proud to be fertile. If that customer was serious and really didn't know that alfredo is more fattening than marinara well I really don't think the physician/NP/PA can help in this situation as they simply don't have the time. Of course, I could get on a soapbox of how the elementary/middle/high school should have a health class...that actually talks about health. The vague memories I have of that time were an occasional seminar (like 1 time a month) on drugs, and once a puberty birds/bees talk. Maybe other parts of the country had a better system, but that was my impression.

 

[cliffhuxtableDO]

With my exercise science background and interest in educating about preventative health measures I'm right there with you guys. In the doctor's office I shadowed in though the doc (granted he is a great doc) really had no interest in taking that approach. It's like he was TOO into medicine and seeing it as the only option once a problem had presented itself.

I think this issue of preventative medicine in America will definitely come from our generation of physicians. Just a generation or two too late... oh well.

 

[CunningCaregivr]

With my exercise science background and interest in educating about preventative health measures I'm right there with you guys. In the doctor's office I shadowed in though the doc (granted he is a great doc) really had no interest in taking that approach. It's like he was TOO into medicine and seeing it as the only option once a problem had presented itself.

I think this issue of preventative medicine in America will definitely come from our generation of physicians. Just a generation or two too late... oh well.

You're so right, but I think we have a lot of work to do. There are so many out there who put up a resistance, saying that it is not cost effective to prevent many conditions (Have we ever tried??!!!! How is this evaluated??)

Our generation needs to create incentive for citizens and practitioners to prevent disease and live healthier. We should first aim at giving physicians reimbursement for educating their patients (i.e. offering health-education programs or having email exchanges with patients). Preventative health should not be a "battle" for us to choose.

Who's with me?

 

[Instatewaiter]

Now it no doubt starts with the physician. He needs to get the ball rolling but IMHO meaningful change will only come when 4 things happen:
1) Physician time is properly re-imbursed

2) Physicians actually take the time to address all the lifestyle issues

3) Patients do the leg work on their own, as well

4) The pt has a support system outside of the physician. A pt will only see the doctor generally either once a year or every 6 months unless they have serious medical problems. It is easy to lose focus in that time. Pts need systems like a trainer, Weight Watchers, visits to the dietician, and support groups to keep them on track.

I hate to sound jaded, but you all will learn after a few years of actually being out there in medicine that you can tell people what to do, you can show them how to change, and give them the tools to change and very, very few will actually make that change. People do not want to change, especially if that change is hard. Americans would rather take the pill than spend months working at it. This is why the gym is busy in January and starts to go back to normal in February.

The largest impediment, IMHO is that patients will not meet you half way. Pts just will not take the necessary responsibility, quite frankly because it is hard. Giving the pt a broad support system will potentially counter this but unless people are really ready to change, it will never happen. People only change when something major, like a heart attack happen. At that point you are well out of the primary prevention spectrum and well into the tertiary prevention, which most would not consider preventative care at all.

 

[DocRyan88]

You're so right, but I think we have a lot of work to do. There are so many out there who put up a resistance, saying that it is not cost effective to prevent many conditions (Have we ever tried??!!!! How is this evaluated??)

Our generation needs to create incentive for citizens and practitioners to prevent disease and live healthier. We should first aim at giving physicians reimbursement for educating their patients (i.e. offering health-education programs or having email exchanges with patients). Preventative health should not be a "battle" for us to choose.

Who's with me?

I agree. If patients had a physician to guide them into a healthy lifestyle, they would probably be more inclined to follow through with it.

 

[Roberie]

LOL, ahhh the gene pool that is swimming out there...makes me proud to be fertile. If that customer was serious and really didn't know that alfredo is more fattening than marinara well I really don't think the physician/NP/PA can help in this situation as they simply don't have the time. Of course, I could get on a soapbox of how the elementary/middle/high school should have a health class...that actually talks about health. The vague memories I have of that time were an occasional seminar (like 1 time a month) on drugs, and once a puberty birds/bees talk. Maybe other parts of the country had a better system, but that was my impression.

Yeah, but only if the teachers know what they're talking about. I grew up in Seattle, though I spent 8th and 9th grade in a small town in Louisiana. Anyway, I still cringe when I remember our 9th grade health teacher explaining how we could eat all the fat/oil we wanted without the worry of gaining weight because, as he implied, our bodies won't digest/absorb it!!!😱

Oh, and just to set the scene, he always carried a can of SKOAL conspicuously housed within his sock! What a role model.

 

[WhitJord85]

The comments in this thread are quite interesting... I too like theory of preventive medicine... I think, if people would put it into practice, it would alleviate many of the problems American are facing most of which stem from our horrific eating habits and lack of regular exercise. However, we as physicians one day can educate our patients and talk to them until we are blue in our face, about what they should and need to do to be healthy and prevent diseases associated with unhealthy lifestyles, BUT... if these people are unwilling and not motivated enough to on a daily basis eat a healthy diet and incorporate some kind of physical activity into their lifestyle, it doesn't matter how much we educate them, if they aren't practiced by the patients.

 

[Yousarrian]

He wants to berate patients like Dr. Perry Cox in Scubs! 🙂

 

[TopQuark]

Would prescribing TCA's(pills) to prevent migraines count as preventative medicine? Or how about prescribing antibiotics prophylactically to prevent COPD exacerbations? Mandating universal vaccinations? Birth control? Frequent and costly screenings for rare but expensive diseases?

Sorry to break up the kumbaya-fest, but preventative medicine isn't just about counseling pts on healthy lifestyles and other things any sensible physician should agree with. Although I agree a physician should work to make their pts healthy(can I get a "duh"?), many more controversial topics can be included under preventative medicine's scope and in today's political climate its important to use a more precise working definition.

I guess what I'm getting at is where's the line between preventative medicine, overbearing medicine, and defensive medicine? Exercise and diet won't cure or prevent everything, and sometimes you gotta prescribe some meds and order some tests.

 

[cliffhuxtableDO]

Would prescribing TCA's(pills) to prevent migraines count as preventative medicine? Or how about prescribing antibiotics prophylactically to prevent COPD exacerbations? Mandating universal vaccinations? Birth control? Frequent and costly screenings for rare but expensive diseases?

Sorry to break up the kumbaya-fest, but preventative medicine isn't just about counseling pts on healthy lifestyles and other things any sensible physician should agree with. Although I agree a physician should work to make their pts healthy(can I get a "duh"?), many more controversial topics can be included under preventative medicine's scope and in today's political climate its important to use a more precise working definition.

I guess what I'm getting at is where's the line between preventative medicine, overbearing medicine, and defensive medicine? Exercise and diet won't cure or prevent everything, and sometimes you gotta prescribe some meds and order some tests.

Of course in the end it health care is a multi-factorial problem, so naturally medicine and tests will be involved. No one said to eliminate those things, but if we can make an effort to encourage exercise and healthy eating medicines and tests will be reduced to a great extent.

At the American College of Sports Medicine one of the major themes throughout the annual conference in 2009 was "Exercise IS Medicine", which is a great starting point for a greater emphasis on preventative medicine.

 

[TopQuark]

Of course in the end it health care is a multi-factorial problem, so naturally medicine and tests will be involved. No one said to eliminate those things, but if we can make an effort to encourage exercise and healthy eating medicines and tests will be reduced to a great extent.

At the American College of Sports Medicine one of the major themes throughout the annual conference in 2009 was "Exercise IS Medicine", which is a great starting point for a greater emphasis on preventative medicine.

To be sure, exercise is good. And I'm not surprised the American College of Sports Medicine would emphasize it at their conference, but doctors are more than personal trainers and dieticians. I feel like "preventative medicine" is the new feel-good, cure-all catch phrase in today's medical lexicon, and I just wanted to remind people that it's a little more complicated than just eating right and working out.

 

[Drrrrrr. Celty]

You have the bedside manner of an angel. I'm sure patients will flock to you by the herd. HA HA, herd since you think all overweight people are lazy cows, right?

Babe.. im just saying.. people are difficult they are very hard to change..
and alright.. are you trying to imply that the majority of overweight people go to the gym and diet properly? I mean get real some people will have chromosomal abnormalities which increase there chances of being obese. however for the majority its due to poor diet and lack of exercise...

No need to get angry...

 

[beckhunter116]

Babe.. im just saying.. people are difficult they are very hard to change..
and alright.. are you trying to imply that the majority of overweight people go to the gym and diet properly? I mean get real some people will have chromosomal abnormalities which increase there chances of being obese. however for the majority its due to poor diet and lack of exercise...

No need to get angry...

I wasn't angry (I'm not right now either 😀) and in multiple posts afterwards I discussed that I think there are lots of topics to discuss in a thread like this and even that people do need to lose weight/exercise it was just your attitude I responded to.

I would think you would have empathy for your patients, because trust me when I say that your patients are going to make plenty of unhealthy decisions and they will never change if all you give them is scorn and a mean, uncaring attitude. And some will never change no matter how helpful and supportive you are.

 

[cliffhuxtableDO]

To be sure, exercise is good. And I'm not surprised the American College of Sports Medicine would emphasize it at their conference, but doctors are more than personal trainers and dieticians. I feel like "preventative medicine" is the new feel-good, cure-all catch phrase in today's medical lexicon, and I just wanted to remind people that it's a little more complicated than just eating right and working out.

No one is arguing with you.

 

[scpod]

..... People only change when something major, like a heart attack happen....

And not ALL people will change then. I can't even count the number of patients with lung cancer, COPD and previous MIs that still smoke. The line fom patients that disturbs me the most is "You have to die from something."

 

[cliffhuxtableDO]

Is the disturbing part that they're right?

Edit: No disrespect intended. I feel like an appropriate response to that would be something along the lines quality of life and the "here and now", as opposed to even mentioning damaging behaviors and dying, because we all do die.

 

[Cybii]

Something I've been throwing around in my head is that once I start up my own practice, I want to do two things:

1.) maybe start up a little newsletter for patients that would address concerns like the seasonal flu, early symptoms for common illnesses, and other topics relevant to their well-being. Maybe add in some healthy-lifestyle tips or nutritional guides. I could have an e-mail that patients can send in questions and I would address common questions in the newsletter.

2.) have some good nutritionists to recommend or refer patents to, and maybe set up some kind of support-system with other patients with the same life-style issues (kinda like their own private weight watchers) where the patients meet up on their own time and be supportive for one another in their dieting/whatever quest. *shrug* Kinda just thought up this idea, still throwing it around in my brain.

 

[cliffhuxtableDO]

I know I'm still only a pre-med but... depending on which specialty I end up in (orthopedics, cardiology, family medicine are probably my top three right now) I want to have a workout facility connected to my practice that will give patients incentives to join and workout at. It might be a fairytale idea, but in my head it sounds pretty cool.

WARNING: if any of you who are already in med school/residency steal my idea, at least give me props for it. haha

 

[beckhunter116]

Something I've been throwing around in my head is that once I start up my own practice, I want to do two things:

1.) maybe start up a little newsletter for patients that would address concerns like the seasonal flu, early symptoms for common illnesses, and other topics relevant to their well-being. Maybe add in some healthy-lifestyle tips or nutritional guides. I could have an e-mail that patients can send in questions and I would address common questions in the newsletter.

At the low income clinic I used to volunteer at did this and I think it is a great resource that they handed out to the patients. It wasn't a newsletter...just a typed up sheet. They also listed what OTC drugs were helpful for a cold vs. flu. They also printed out the list from walmart/target for $4 drugs so that people could find affordable drugs.

 

[Cybii]

At the low income clinic I used to volunteer at did this and I think it is a great resource that they handed out to the patients. It wasn't a newsletter...just a typed up sheet. They also listed what OTC drugs were helpful for a cold vs. flu. They also printed out the list from walmart/target for $4 drugs so that people could find affordable drugs.

That's great!

I know I'm still only a pre-med but... depending on which specialty I end up in (orthopedics, cardiology, family medicine are probably my top three right now) I want to have a workout facility connected to my practice that will give patients incentives to join and workout at. It might be a fairytale idea, but in my head it sounds pretty cool.

WARNING: if any of you who are already in med school/residency steal my idea, at least give me props for it. haha

That does sound awesome! I'll give you some props if I ever steal your idea. 😛

 

[Drrrrrr. Celty]

I wasn't angry (I'm not right now either 😀) and in multiple posts afterwards I discussed that I think there are lots of topics to discuss in a thread like this and even that people do need to lose weight/exercise it was just your attitude I responded to.

I would think you would have empathy for your patients, because trust me when I say that your patients are going to make plenty of unhealthy decisions and they will never change if all you give them is scorn and a mean, uncaring attitude. And some will never change no matter how helpful and supportive you are.

Im empathetic.... however after doing social work at high school i have dont believe much in humanities ability to change. My sympathy is something that i usually need to see in human nature and the will of the person.
Of course the fact is that since im a sociology/psychology person i know that people relatively difficult and expecting change without some sort of life changing event is very difficult. However its your duty to tell the person what to do and what will happen if they dont. Its their duty to listen and do what you tell them, if not well then its there failure not the doctors. Shun yui (art of war) will also agree with this outlook and yes i know ridiculous comparing medicine to war, but hey.. Its a good analogy/metaphor 😀.