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Monday, March 30, 2009

Should "preventionists" treat the population and real docs treat individuals?

I had not heard the term "preventionist" before reading this excellent entry by Dr. Michal Accad. His thoughtful essay in part delves into a topic that has interested and bothered me for years, the individual versus the collective and in the medical context population health versus individual health.One of my rants on this topic can be found here. (One indicator that you probably have run out anything to say is frequently quoting yourself.)

I quote his final paragraph wherein the term "preventionist" appears, I think tongue in cheek.

... But since population medicine has little to do with individual medicine, and since the application of primary prevention requires no diagnostic skills to identify the subjects of predilection, the advocated intervention need not be practiced in the doctor’s office. I propose that JUPITER’s precepts be promoted in specialized “Centers of Excellence,” public health dispensaries where competent preventionists could directly indoctrinate the public to the many values of the modern wisdom, un-distracted by the chaotic environment of a clinical practice. And thus relieved from the burdens of a task at which they are so woefully “inefficient,” the primary care physician could then return to their humble original calling, the care of a patient with a chief complaint.

The primary care physician increasingly is called upon to to be a preventionist under the threat of being accused of not practicing quality care and not receiving his bribe (aka P4P ).

My favorite P4P quote continues to be:
"He hands you a nickle.He hands you a dime.He asks you with a grin are you having a good time"...Dylan from Maggie's Farm.

Prevention is one of the holy trinity (along with EMRs and quality systems) that will bring the new age of greater health for all, less money spent and really good care for everybody. In terms of the world of the internist, it is the office internist (one variety of the officist) upon whose shoulders falls the obligation to ensure his patients (clients, customers) have been quizzed and then instructed to do whatever they are supposed to do to strive for wellness from submitting to colonoscopies and flossing and using their seat belts.The other sub-species of internist (the hospitalist) can still for the most part manage sick patients leaving the administrative tasks of prevention to his 8-5 office cousins and increasingly to their extenders.

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