Preventive medicine: Medical practices that are designed to avert and avoid disease. For example, screening for hypertension and treating it before it causes disease is good preventive medicine. Preventive medicine takes a proactive approach to patient care.
Clinical medicine and medical education often intersect in intriguing ways. The concept of Preventive Medicine, defined above, is well understood and accepted in medical practice. Fundamentally, the concept involves:
- Identification of modifiable conditions that promote development of a particular disease, called “risk factors”. (The term “modifiable” is key here, since many known risk factors, such as family history and age, are beyond our ability to influence).
- Detection of those who harbour the risk factor
- Development and implementation of strategies or treatments to prevent or neutralize the culprit risk factor
In my own field of cardiology, hypertension, hypercholesterolemia, and smoking are among the most well established risk factors, all known to contribute to the development of coronary and cerebral vascular disease. All are modifiable through lifestyle changes and appropriate application of medications.
The challenge of preventive medicine, of course, is that folks who have these risk factors are unaware and feel fine before they actually develop symptomatic manifestations of vascular disease. It’s therefore often difficult to detect them and, once detected, convince those at risk that they should change their lifestyle or accept the need to take a medication (with potential for unwelcome side effects). The challenge for physicians promoting and practicing Preventive Medicine is therefore considerable. It requires them to not only be aware of the science and evidence related to risk modification, but to develop personal and effective relationships with their patients. It requires much more than dogmatic pronouncements. “Do what I say because I know better” seldom works, or survives the first minor adverse effect. It requires, dare I say it, a relationship of trust. Patients accept preventive treatment not because of the diploma on the wall, but because of they trust the intentions and motivations of the person providing the advice. That trust, in turn, is rooted in a distinctly human and interpersonal perception that the physician truly cares for them and is making recommendations solely on that basis. Patients, I’ve come to believe, possess an almost instinctive ability to perceive authentic altruism in medical encounters.
Medical students are also an “at risk” population. As many studies have demonstrated, rates of “burn out”, mental disorders and even suicide, exceed rates expected in the general population. (http://jamanetwork.com/journals/jama/article-abstract/2589340)
Unfortunately, prevention of medical student risk remains an imprecise science, with much speculation but little objective evidence that would guide appropriate preventive interventions. Nonetheless, here at Queen’s and at medical schools across the country, curricular leaders are not content to simply respond to crises that emerge, but are developing approaches they hope will raise awareness and allow students to identify and modify risk in themselves and their classmates. They are, in essence, extending the principles of Preventive Medicine to the world of medical education.
At Queen’s, Dr. Renee Fitzpatrick and the Student Affairs team has developed a Wellness program that is not an “add on”, but rather embedded within our core curriculum. That approach embraces multiple components, including didactic content, embedded scenarios, easy and confidential access to help, and Wellness Retreats. The latter are half-day sessions planned in conjunction with the students themselves, to promote awareness and preventive interventions.
In addition, the recently revised School of Medicine strategic plan will, for the first time, identify Wellness as a strategic priority for all our programs.
The major challenge, as with any preventive strategy, will be to reach those who are at risk but unaware, and are therefore the most reluctant to engage the issue with necessary commitment. The reluctant include both students and faculty. In addressing this difficult but critical challenge we must recall the lessons of the clinical world, that effective intervention must be rooted in the development of trust, and that trust evolves naturally from truly caring about the welfare of those affected
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education