Preventive Care Visits
Her Concerns
Start with her concerns: the patient sets the agenda
History of Past Health, Family History, Social History
give non-evidence-based lens to look through
use clinical judgement; peer or best practices, or personal experience; often clinical evidence
Evidence for What Is to Be Done
Canadian Task Force on Preventive...
Smoking
Ethanol
Eating (adequate, low fat)
Hypertension
Immunization
Sexual screening (offering OC, pap, BE/Mammogram)
- about 20% of teens get pregnant in Nova Scotia, almost overwhelmingly which end in termination
Limit noise and sun exposure
Injury prevention (drunk driving, seatbelts, helmets)
Flossing, fluoride, brushing
Exercise moderately
Stools for occult blood
Risks:
- HPH: obesity, diabetic proteinuria and retinopathy, depression, stroke
- Family History: melanoma, TB, EtOH, breast cancer
- geriatrics: injuries, fall assessment, vision, hearing, dementia
Obstacles to Preventive Care
little training
lack of funding and high overhead costs
lack of negative consequences for avoidance
lack of rcall systems
patients as anxious seekers; how do you reach people who don't care?
- non-volunteering patients are very often the ones who get sick...
