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What Is Secondary Prevention?

A November letter to the editor in American Family Physician chastises that publication for misusing the term “secondary prevention,” even using it in the title of an article that was actually about tertiary prevention.

I am guilty of the same sin. I had been influenced by simplistic explanations that distinguished only two kinds of prevention: Primary and secondary. I thought primary prevention was for those who didn’t yet have a disease, and secondary prevention was for those who already had the disease, to prevent recurrence or exacerbation. For example, vaccinations would be primary prevention and treatment of risk factors to prevent a second myocardial infarct would be secondary prevention.

No, there are three kinds of prevention: Primary, secondary and tertiary. Primary prevention aims to prevent disease from developing in the first place. Secondary prevention aims to detect and treat disease that has not yet become symptomatic. Tertiary prevention is directed at those who already have symptomatic disease, in an attempt to prevent further deterioration, recurrent symptoms and subsequent events.

Some have suggested a fourth kind, quaternary prevention, to describe “… the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.” Another version is “Action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.” But this is not a generally accepted category. Read more »

*This blog post was originally published at Science-Based Medicine*

Why The Term “Patient” Is So Important In Healthcare

An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare.

My vote is: PATIENT. Here’s why:

Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of the rela­tionship. If a person with illness or medical need became a con­sumer like any other, the rela­tionship — and the doctor’s oblig­ation — would be lessened.

Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the prac­ticing physician’s per­spective, it’s a priv­ilege to have someone trust you with their health, espe­cially if they’re seri­ously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.

*This blog post was originally published at Medical Lessons*

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