My recent schedule has regrettably made it a bit tricky to write over the past couple of months. After getting home from a long day, seeing friends or going to the gym has usually trumped making a post. Hopefully this will be the first of several to get back on track.
Throughout this past week, a common theme keeps popping-up when I talk to friends – particularly to those not in healthcare. That is, the value of preventative medicine. There are different types of prevention: primary, secondary, tertiary and primordial. Primary prevention deals with stopping an illness from occurring in the first place (e.g. avoiding lung cancer by not smoking). Secondary prevention is to catch a disease after it starts, but before symptoms appear, such as through screening techniques (e.g. colonoscopies for colon cancer). Of course this has to be an illness that can be readily treated at the stage it is diagnosed, and in a non-invasive and affordable way. Tertiary prevention involves rehabilitation after a disease or illness has begun to manifest itself (e.g. pulmonary rehab). Lastly, primordial is making changes on a population level through Health Canada and public health (e.g. banning smoking on public places).
For the purpose of this post, I will focus on a subject that is close to my heart (no pun intended): cardiovascular health!
Much money and many investments are dedicated into treating pathology of the cardiovascular system. Consider plaque buildup of your coronary arteries (the blood vessels that feed your heart). If these plaques accumulate too much, one becomes high risk for suffering from a heart attack. So much money is spent on treatments for people experiencing a heart attack, either through stents (angioplasty) or a more invasive alternative, such as open-heart surgery. Additionally, there is an entire market of pharmaceuticals focused on the management of people who have had a heart attack: Plavix, beta-blockers, alpha-blockers, diuretics, and many more. In fact, statins (often used to lower bad cholesterol in the blood) are the most commonly prescribed medications on the market.
With a greater focus on primary prevention, this burden can be shouldered. Despite this, only 1% of healthcare costs are devoted to primary prevention and promoting healthy lifestyle. Most of this is done through family physicians and regular check-ups, but some specialists are starting to emphasize it as well (such as preventative cardiologists). Central to this is the issue of time management, inadequate primary literature, and poor remuneration. Efforts are being put towards stressing primary prevention, albeit slowly. This is something that I am looking forward to pursuing once I start practicing, and that I have already begun to push with many of my patients. I am excited to see what direction our system will go regarding the value of primary prevention.