Medical Associates Clinic

 Quality Care Close To Home

PREVENTIVE MEDICINE, 2004

     When I was in medical school, sleep was a rare commodity.  If we weren’t up learning how to care for patients in the middle of the night, we were supposed to be reading and studying on how to care for patients.  I, like many of my classmates, slept through more than one class because I just couldn’t keep my eyes open.  In order to help us stay awake, I am sure that our professors spent a disproportionate amount of time talking about the more exciting and dramatic aspects of medicine.  The class always woke up when the professor would talk about how to take care of a heart attack or an acute appendicitis, or the injuries from a moving vehicle accident. They would fall back to sleep when he began to drone on about wearing a seatbelt, taking medicine for blood pressure, or what immunizations an adult should get.  Preventive medicine just wasn’t very exciting.

     And yet preventive medicine is really the backbone of our clinic practice.  When I first came to Pierre in the early 1980’s, there was a new clot-melting medicine called streptokinase that was being used for heart attacks.  I used it 20 times in one year in 1982.  Over the years, my practice evolved more and more into preventing heart attacks from every occurring.  I would like to believe that that effort has resulted in my not having to use the clot-melting medicine for a heart attack for the past year.  It sure is a lot easier on patients to take a cholesterol or blood pressure pill and stop smoking than it is to come into the hospital with an acute heart attack.  With an acute heart attack the patient needs clot-melting medicine and then a cardiac catheterization and maybe bypass surgery. The high cost of our hospital medicine dwarfs that which is spent on preventive medicine.

     At the risk of putting everybody to sleep, the New Year’s column seems the appropriate time to list those factors most important in preventive medicine.  Listed below are some of the more effective medicine steps a person can take to protect their health:

1.  Stop smoking.  Smoking is the single worst health hazard that a person can have.   If a person smokes cigarettes, there is a 50% likelihood that their smoking habit  will be the cause of their death.  Interestingly, those who attempt suicide are only successful about 10% of the time.  Smoking cigarettes is 5 times more likely to kill a person than if the person makes a suicide attempt.
 2.  Weight control.  So much has been said about this already.  Suffice to say, that a 25 year old individual with a body mass index of 30 or more, is giving away 6 years of life.  If the body mass index is 40 or more, that person is giving away 15 years of life compared to the general public.
 3.  Control blood pressure in the normal range of 130/80 or less.    There is no such thing as normal high blood pressure.  Blood pressure control prevents heart attacks and one of the things that people hate most of all – strokes.
 4.  Control cholesterol.  High blood cholesterol is one of the major contributors to heart attacks, strokes and peripheral vascular disease preventing a person from walking.
 5.  For woman – get an annual mammogram.  The cure rate for cancers of the breast is 80% for those women whose breast problem is found on a mammogram.  Breast cancer is the second leading cause of cancer deaths in woman.
 6.  For men – check the prostatic specific antigen.  Prostate cancer is the 3rd leading cause of cancer death in men.
 7.  Wear seatbelts in your car.  Not only is it great preventive medicine but it is also the law in South Dakota now.
 8.  For those over age 60, check a bone mineral density to ensure that the potential for osteoporosis is dealt with.  Broken hips and broken vertebrae in the back don’t kill a person directly but the pain can be disabling and life changing.
 9.  At age 50 or after, have a flexible sigmoidoscopy done to check for precancerous polyps in the colon. Cancer of the colon is one tumor that can be prevented (even better than cured) by surveillance techniques that remove precancerous polyps before they become cancerous.  Cancer of the colon is the 2nd leading cause of cancer deaths in men and women.
10. Exercise.  Many, many studies have shown that adults who exercise maintain both mental and physical capability better than individuals who do not exercise.

     As I look back over this list of ten items, I see where some people might fall asleep before they get through.  One of my preventive medicine professors offered an interesting perspective.  He said that many people went into the medical field because of the excitement of acute care medicine.  They enjoyed the dramatic surgery and dealing with catastrophic events.  These “adrenal junkies” tend to congregate into surgery and emergency medicine.  Other physicians, not needing or wanting the adrenalin rush, entered into  family practice, internal medicine and pediatrics.  From a patient’s perspective, it is not a chosen or recreationally valuable experience to meet up with surgeons or emergency medicine physicians.  Observe that it is the job of family practitioners, internists, and pediatricians practicing preventive medicine that prevents the patient from meeting up with the surgeons and emergency medicine physicians.  The professor told me that patients have a choice.  They can have the choice of listening to preventive medicine suggestions now or have the excitement of meeting a surgeon or an emergency medical physician later.  I say to all of you now, take your pick.

     Have a Happy New Year!!!