Much of my medical training in residency and fellowship was all about learning to react to particular clinical situations. Long nights of call with exposure to a high volume of patients allowed me to quickly recognize common signs and symptoms, develop a working differential diagnosis and initiate testing and therapy right away. This rapid fire exposure to disease was incredibly important in my development as a physician. Moreover, the ability to react to clinical findings is essential in providing quality medical care as well as producing positive outcomes.
However, very little of my training focused on prevention. Even today, residents and other physicians in training spend far more time treating disease rather than figuring out how to derail the disease process (even before it begins). Certainly, we all learned about proper timing of routine screening tests for colon cancer, breast cancer, prostate cancer, etc. In contrast, we did not spend much time learning effective ways in which we could counsel patients about lifestyle modification and risk reduction. We did not talk much about how to educate patients about potential diseases that they may be at risk for and the potential negative impacts these diseases might have on an individual patient’s overall health status and quality of life.
Today in the Wall Street Journal, an article detailing a new report of an overall reduction in preventable cardiovascular death in the US today was published. On first blush, this sounds like a very positive report–fewer Americans are dying of heart disease. However, on closer examination, the data becomes quite disturbing–the largest reduction in preventable death was in the older population (greater than 75). In the younger population (age less than 65) the decline was much less impressive. Subgroup analysis revealed significant racial and geographic disparities as well–African Americans had a two fold higher rate in preventable cardiovascular death. Residents of the southern states were also found to have much higher rates of preventable death.
Why is this? What can we do to impact the large number of preventable cardiovascular deaths?
Based on this data, it seems to me that we are now seeing a large number of younger patients who are at risk for cardiovascular disease that are not being aggressively screened, evaluated and treated. Many of these younger patients are not seeking medical attention until they experience their first (and often fatal) cardiac event. According to the CDC nearly a quarter million of the 800K annual cardiovascular related deaths are preventable. Long standing cardiovascular disease and its myriad of complications are expensive…in terms of dollars and in terms of human life.
The solution is all about prevention. As cardiologists we must be more vigilant and screen young at risk populations more aggressively. We must treat hypertension, hyperlipidemia and diabetes in younger patients. We must spend more time counseling patients about lifestyle modification–not just smoking cessation. Other healthcare providers in both primary care and in other specialties must also redouble their efforts on prevention. We must all work together and refer patients who are at risk to the proper provider. In addition, we must pay extra attention to higher risk groups such as minorities and we must focus efforts in geographies such as the south with higher than average preventable death rates.
Most importantly, we must all work to change the mindset in medicine. Clinical competence and the ability to think on our feet and react is certainly essential and should remain a cornerstone of training. However, we must also look a little deeper. Obviously, we all love to be cast as the hero in the medical drama and save a life with an emergency procedure–however, it is just as heroic to prevent the emergency in the first place. We must strive to train physicians who not only are able to react to disease and its presentations but who are also adept at recognizing risk and counseling patients to prevent negative outcomes later in life.
Ben Franklin had it right way back in the 1700s. Even though we didn’t listen to Ben then, we have a real opportunity to listen and act now! Remember–”an ounce of prevention is worth a pound of cure!” Now that’s a low cost way to reduce the costs of healthcare AND save lives in the US today.