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Well, when I inquired about nutrition curriculum during interviews, I received the same hit-or-miss (mostly miss) answers as MD schools. They both tend not to emphasize it, which says a lot about their focus on preventive care. Disappointing.
OTOH, if you train more PCPs, you're helping the world maintain better health (essentially). But just because a schools *says* it wants to train PCPs doesn't mean it's actually *doing* anything to achieve this goal. Personally, LECOM, with its 3-year PC pathway, is one of the only schools I'm convinced is truly committed to such a goal. But that's another issue...
OTOH, if you train more PCPs, you're helping the world maintain better health (essentially). But just because a schools *says* it wants to train PCPs doesn't mean it's actually *doing* anything to achieve this goal. Personally, LECOM, with its 3-year PC pathway, is one of the only schools I'm convinced is truly committed to such a goal. But that's another issue...
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deleted212936
lol
one more question, please:
Do PCPs engage in more preventive care than specialists ?
one more question, please:
Do PCPs engage in more preventive care than specialists ?
If you're seeing a specialist, you're sometimes outside of the "preventive" stage of a given ailment/disease and have moved into the "treatment" or at least "evaluation of disease" phase. These "phases" are arbitrary.
OTOH, specialists can counsel you on, for example, prevention of worsening symptoms via specialized techniques/exercises/therapies unfamiliar to a PCP.
Lots of examples and counter examples. This is by no means a definitive answer to your question, nor am I an expert.
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My father is a gastroenterologist (specialist) who is into prevention. He will talk to his patients about the importance of eating enough fiber in their diets... and will talk to patients who have fatty liver disease about how to prevent their condition from worsening. Those are just a few examples of what he does. Similarly, someone like an endocrinologist can counsel patients on controlling conditions like diabetes or PCOS with diet/lifestyle modification in combination with pharmaceuticals. So a specialist can still incorporate some form of diet and lifestyle discussions with their patients as well.
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That's awesome! I wonder how he perceives the use of preventive therapies/counseling by his colleagues.
Yeah but what brings the patients to him in the first place? Colonoscopies I'd imagine since those are supposed to be semiregular for middle aged people, but in following CBs point, aren't a lot of people (aside from colonoscopies) going to a GI because they have a problem, rather than just preventitive care?
Yes, I'm sure a bulk of his patients come to him initially for colonoscopies, far moreso than those coming in to him due to direct pains.
Screenings are considered a form of 'secondary' prevention, as they help prevent cancers from developing/metastasizing in the early stages.
'Primary' prevention would be considered a preventive intervention that occurs BEFORE any disease takes place. I seriously doubt any one comes into him just to learn about preventing colon cancer. If someone has a mere bout of constipation, I'm sure that something they discuss with their PCP before seeing my dad. Most people don't come in for care until the 'secondary' (screening) or 'tertiary' (pain/disease occurence) level.
I simply mean that once patients are already there to see him, then he can still talk to them about other preventive issues affecting their digestive health once they are already in his office. He loves to teach, and spends a lot of time with his patients.
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Realize too, that with some patients preventative medicine is useless. These people are probably in the minority of individuals, but they do exist.
Yes, exactly. Very well said. I especially appreciate your knowledgeable explanation of what constitutes prevention and it's stages, i.e., primary, secondary, tertiary. I think a lot of people throw around the term "prevention," which is a key buzzword these days, w/o actually understanding what it means.
Nearly all physicians participate in preventive medicine at some stage, but I think when people talk about prevention, they are mostly talking about primary prevention. While some elements of primary prevention are pretty automatic in the PCP setting, such as vaccination, diet/lifestyle counseling (metabolic syndromes), STI education/prevention, education on high-risk behaviors, but we could definitely do a better job w/ these and there are also many other subsets, some of which may be more specific toward a particular population, that can be improved upon, as well. Unfortunately, there are a lot of pressures that make it more difficult for PCP's in this area. Part of the problem is systemic. We need to address the larger issues surrounding our healthcare system, one of which is placing the physician-patient partnership back into the driver's seat in terms of individual healthcare advocacy (instead of insurance, time, and finances).
Sounds like a good doctor to me. Good example for us all. 👍
Just like other areas of education, one may have to take it upon themselves to keep up with preventative healthcare measures. Most of the stuff really isn't complicated but there are definitely things that are. There really isn't an incentive (aside from a warm fuzzy feeling) for most doctors to aim for it. We like to pay a ton for procedures. Those dollar signs or always in the back of your mind to some degree. I have a personal interest in injury prevention when it comes to sports and what not, but many of the preventative measures for something as simple as protecting your knee are A LOT of work on multiple fronts. Lots of the stuff you can do takes more money than is currently provided. You get stuck with things like "eat healthy", "don't smoke", "use proper lifting techniques", etc. Diving deeper into those simple orders goes into a whole new realm.
I know specialists that are very very very into that stuff as much as they can be and primary care that aren't. It holds no boundary between MD and DO. (I probably know a few more DOs that are into it than MD but not enough to make it a reliable source)
Now, things like basic medical checkups, colonoscopies, stress tests are always good but that requires the patient to understand that these tests are good too.
I know specialists that are very very very into that stuff as much as they can be and primary care that aren't. It holds no boundary between MD and DO. (I probably know a few more DOs that are into it than MD but not enough to make it a reliable source)
Now, things like basic medical checkups, colonoscopies, stress tests are always good but that requires the patient to understand that these tests are good too.
I agree, its not so much preventive medicine as it is preventive education. And like anything its best to learn when youre young (pediatricians and grade schools).
I know that inherently, your relation with a PCP can set the stage for health in later life (i.e, who is brave enough to tell the long time patient that they've gained weight... enough such that they need to take action.) But as a future physician, I'd like you to remember that there are professionals in hospitals, and doctors offices, and in private practice around the country who receive extensive education in prevention of chronic disease: DIETITIANS!!! (How exciting! Yesss!) You can refer your patients to a dietitian, and they in turn can help your patients make lifestyle changes that will help them avoid chronic disease. This is awesome. Obviously, I get a little excited about it. I can assume that in a regular doctors visit, most PCPs aren't going to take an hour to talk about portion sizes, exercise, barriers to change, or the emotional/psychological aspects of eating. A dietitian can. Don't forget the resources you have to refer to!
Oh, and also- NYCOM has a combined MS in Clinical Nutrition/ DO program, that helps you become eligible to be a PNS - physician nutrition specialist. So there is that 🙂
Sorry for the overwhelming enthusiasm.
Oh, and also- NYCOM has a combined MS in Clinical Nutrition/ DO program, that helps you become eligible to be a PNS - physician nutrition specialist. So there is that 🙂
Sorry for the overwhelming enthusiasm.
Don't apologize for it--we all need to be aware of the great resources available to our patients, such as dieticians and the like. 👍
Agreed definitely. It'd be great if pediatricians recommended seeing dieticians, and the parents actually followed through on it; start at the beginning. Somehow I'd imagine that the parents are the biggest obsticle.
Actually, the biggest obstacle is getting insurance to cover seeing a dietitian. It varies widely among private insurance, and medicare/medicaid is worse. At this point, seeing a dietitian is only covered through medicare/medicaid if a) you have diabetes or b) kidney failure/ transplant. There is recent progress towards allowing coverage for childhood obesity- which is awesome- but still not 100%. In order for there to be increased coverage for nutrition care, there needs to be a push on all sides- parents, health professionals, and the dietitans themselves- to advocate for better insurance coverage for preventative care. Increased insurance coverage = increased access for everyone. Tell your friends. 🙂
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