An Ounce of Prevention

An ounce of prevention, it is said, is worth more than a pound of cure. Medicine in recent years has been oriented to “cure” rather than prevention, even though many of the greatest medical successes, such as eradication of smallpox and control of paralytic polio, have been achieved through preventive measures. We have been “crisis-oriented”: our approach has been to wait for a consequence to appear and then try to treat it. Now, interest is appropriately focusing upon preventive medicine. The most important part of preventive medicine, moderating health habits, was discussed in my previous posts. The idea of preventive medicine also includes the following four strategies, and it is important to understand both their strengths and their limitations;

The checkup or periodic health examination
Multiphasic screening
Early treatment
Immunizations and other public health measures

The Myth of the Annual Checkup

The “annual checkup” is still recommended by some schools, camps, employers, and the army. Curiously enough doctors seldom go to each other for routine checkups, nor do they send their families. The complete “executive physical,” made popular a few years ago by large corporations that wished to insure the health of their most critical employees, is slowly being discontinued. Even these elaborate checkups, involving several days in the hospital, do not detect early and treatable diseases with any regularity, and they raise false confidence to some degree. That is, they encourage the false belief that if you are regularly checked you do not need to concern yourself as much about personal health maintenance.

There are a few areas in which periodic screening is necessary, and it is important to keep them in mind:

High blood pressure is a significant medical condition that gives little warning of its presence. During adult life it is advisable to your blood pressure checked at least every year or so. This measurement can easily be done by a nurse, physician’s assistant, or nurse’s aide; a full examination is not required. If high blood pressure is found, a doctor should confirm it, and you should carefully attend to the measures needed to keep it under control.
If you are a women over twenty-five, you should have a “Pap smear” taken every year or so. Some authorities now recommend beginning Pap smear testing at the age of beginning sexual activity, decreasing frequency to every three to five years after the first three are negative and again increasing the frequency to every one or two years after age forty. This test detects cancer of the womb (cervix), and in early stages this cancer is almost always curable.
Women over age twenty-five should practice breast self-examination monthly. Any suspicious changes should be checked out with a physician; the great majority of breast cancers are first detected as suspicious lumps by the patient. Women with large breasts cannot practice self-examination with as much reliability as other women and may wish to discuss other screening procedures with their doctor. In general, we do not like to recommend mammography as a screening procedure for women below the age of fifty, but there are exceptions, such as women who have already had a breast tumor or women with a strong history of breast cancer in their family.
A test for glaucoma (a treatable disease that can cause blindness) should be done every few years after age forty if there is a family history of glaucoma. Most cases of this disease are discovered during eye examinations, so it is generally advisable that such examinations include a routine check for glaucoma.
Tuberculosis skin tests (PPD or Tine Test) or periodic chest X rays are indicated if there has been any possibility of exposure to this disease. If the skin test was negative and becomes positive, check with your doctor.
Dental checks can save teeth, and regular dental examinations are recommended. The primary purpose of an annual dental examination is to find and fill cavities; the benefits of other aspects of the examination ritual are less well established.
Screening tests of Urine, tests for blood in the stool after age thirty, and regular sigmoidoscopy after age fifty are of more dubious value. Some doctors feel that these are worthwhile, and others do not.

The importance of these few examinations is underscored by their availability as a public service, free of charge, at many city and country clinics. These are the crucial elements of periodic checks; others are optional and controversial.