An apple a day keeps the doctor away? Is prevention better than cure? What about an annual physical examination? Is that the best way to stay healthy? Many people think so.
The truth is that all of us are, to greater or lesser degrees, prisoners of ritual, says Dr. Richard Goldbloom, MD, in an editorial in the Canadian Medical Association Journal (CMAJ). We perform these illogical practices to reduce our level of anxiety or, at least, to prevent it from rising.
Dr. Goldbloom is a Professor in the Department of Pediatrics, Dalhousie University, Halifax, NS.
In 1980, the Canadian Task Force on the Periodic Health Examination (now called the Canadian Task Force on Preventive Health Care) recommended that the routine annual physical examination should be discarded in favour of a selective plan for prevention to suite individual requirement.
Many physicians disagree with this recommendation.
Currently, physicians are inundated with clinical practice guidelines that are based on sound scientific evidence. But not many physicians buy into these guidelines as they conflict with the percieved needs and expectations of patients and physicians, Says Dr. Marie-Dominique Beaulieu and others in the same issue of the CMAJ.
Dr. Beaulieu is a Professor of Family Medicine at the University of Montreal, Montreal, Quebec.
The study conducted by Dr. Beaulieu and others, show that the majority of the physicians and patients find the annual check-up beneficial for variety of reasons. One important reason is that check-up permits a more thorough evaluation than regular medical visits. It also builds trust.
The authors say that tests play an important role for patients in their personal preventive routine. Patients considered test results more accurate than the history and physical examination.
Physicians value the history and physical examination much more than test results. Since there are very few truly effective screening tests, physicians feel the downgrading of the annual check-up unacceptable.
A screening test should have some effect on the disease process and offer gain in life expectancy to the majority of the people who under go such tests.
But there are many drawbacks to offering the public preventive therapy. It creates unnecessary anxiety. It exposes the public to procedural complications and the risks of false-positive and false-negative results; and it creates an unhealthy preoccupation with disease among the public.
It has a potential to induce fear.
Over use of diagnostic procedures for screening purposes creates long waiting lists. Thus the patients who would most gain from the test may be deprived of the benefit.
Another attractive concept has been widely promoted is the belief that if more money were spent on prevention, less would have to be spent on treatment a concept that, with a few exceptions, does not stand up to close scrutiny, says Dr. Goldbloom.
For physicians and patients, annual check-up and tests relieve anxiety. To them, this is more important then worrying about clinical practice guidelines. For the preventive medicine experts, the biggest challenge is to bridge the gap between science and ritual.
Dr. Goldbloom says, physicians, like patients, are just plain folks after all, enslaved to ritual and tradition, reiterating beliefs and practices that both groups believe, logically or not, have served them well.
So, dont forget your apple today!
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