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*
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*
This past week I learned several new words and phrases. Allow me to share a few with you.
“Speedo sag” –- I learned of this phrase from a tweet from @BAAPSMedia:
Have just seen a cosmetic surgery press release about so-called “Speedo Sag”….Eww.
My first thought was the same as my OR crew, whom I polled. We all thought it had to have something to do with the parts of the male anatomy which should be covered by the Speedo, such as perhaps the scrotum. It doesn’t. Read more »
*This blog post was originally published at Suture for a Living*
Doctors trying to help patients understand a course of treatment must teach them new terms such as “medical evidence,” “quality guidelines” and “quality standards.” Patients might not be willing to accept that language lesson.
A study in Health Affairs concluded that 41 percent of patients didn’t ask questions or tell doctors about problems. The main barriers were that patients didn’t know how to talk to doctors, or their physicians seemed rushed. Only 34 percent of patients recalled physicians discussing medical research in relation to care management.
But, physicians say, that’s only half the problem. Sometimes, patients demand to see specialists when they don’t really need to. Or, they don’t accept it when evidence shows that highly-desired treatments aren’t the best ones for care. One reason may be that one in three patients believe that more expensive treatments work better than less expensive ones, according to the study in Health Affairs. Once the evidence is laid out, it can be a delicate negotiation to get patients to accept that. (American Medical News, Health Affairs, RangelMD, KevinMD)
*This blog post was originally published at ACP Internist*
It’s been a very long time since I did an “Ask Dr. Rob” post. It’s also been a long time since I shot a spitball out of a straw and hit someone behind the ear during social studies class. I realize that just because it’s been a long time since I’ve done something, it doesn’t mean the world is better off with me doing it again.
Still, there have been some interesting questions that have come up and I think it’s time they should be answered. They’re both along the same line:
Question 1: What’s the difference between health care and healthcare? I see that you contribute to the Health Care Blog, but you write about healthcare all of the time. What’s the deal?
Question 2: What’s the difference between EMR and EHR? It seems that some people feel that it’s vile and uncouth to call it “EMR,” only accepting people who call it “EHR” into their secret societies of people who are smarter than everyone else. What’s the deal? Read more »
*This blog post was originally published at Musings of a Distractible Mind*