Preventative Medicine

I just got told off by a guitar repairman who was not so pleased that I didn't use a guitar stand and hadn't brought in my mom's guitar to the store in a case. It's true...if the guitar had been on a stand Catastrophe wouldn't have been able to knock it over, breaking the head. Sure he can fix it, but the repair will be expensive, it won't be good as new and the whole incident could have been prevented if we had taken better care of the guitar from the beginning. He sure made me feel like an idiot...it's just a guitar!!!!! I know a mechanic would probably have similarly harsh words about the condition of my car.

Oh preventative medicine...it makes such intuitive sense. Why not prevent a problem instead of finding elaborate, expensive, painful ways to fix it. Sure habits are hard to change, but why not have a healthy diet and exercise a little instead of getting type II diabetes. And once you have diabetes why not take your medication and avoid eating tons of donuts instead of requiring expensive hospital admissions for foot ulcers, kidney damage, amputations, etc. that eventually lead to an early death. Seriously. Health care just needs a change of focus as described in the article "Making Health Care About Health". We'd be a lot healthier as a nation. While I fully believe in preventative medicine, maybe I don't believe enough in people. One of the reasons I'm drawn to pediatrics is that kids are kids, they shouldn't yet know better and they are totally dependent on others so they need all the understanding help they can get. I do not want to deal with adults who won't follow medical advice, won't stop smoking or eating triple cheeseburgers even when it's obviously killing them (of course I've gained 5 pounds in the past month due to being sick, never exercising and eating all my mom home cooked meals). Issues such as access to healthy foods and safe places to exercise are understandble and most definitely need to be addressed, nothing is ever as simple as it sounds. That's why public health initiatives are incredibly important. It would be the general unwillingness of a patient to take on an active role in their health that I know would drive me crazy pretty quickly.

I've discovered that while I think patients need to be told about the importance of preventative medicine, I don't necessarily want to be the person doing it. All of the well child exams I've seen in general pediatrics have been fun due to the kids, but at the end of the day most don't serve much of a purpose beyond reassurance and occasionally some education. If we didn't do well child exams, 95% of the kids we see would be just fine regardless. Still it's that remaining 5% that it's important to catch...just like in prenatal care. However, as I'm encouraging kids to eat more fruits and vegetables, exercise more and wear their bicycle helmet I wonder if I really need 7 plus years of education to dispense this common sense. Of course, maybe it means more coming from a doctor, and if it actually inspires people to follow the advice that's great. Long term I think I'd rather deal with the kids with more serious problems, but we'll see how this all plays out.

Vaccines are an important part of preventative medicine too. Just look at polio. The number of vaccines given to kids has skyrocketed even since I was little and it's done a lot of good. And inspired some unfounded fear. Pediatricians (or their nurses) are at the frontlines of most vaccination campaigns. The flu clinics have been crazy with everyone scrambling for the H1N1 or seasonal flu vaccine (though some parents are afraid, there is still way more demand than supply). I'm fortunate the varicella vaccination came a long right when it did so hopefully I'll never get chicken pox. And it looks like an HIV vaccine is slowly becoming more than just a dream. Still vaccines can't fix everything...as the director of trauma surgery said, "Unfortunately there's no vaccine for bullets".