Preventative medicine. What do these words mean to you?
As doctors, we tend to think of preventative medicine in a very concrete way. It’s the underlying mantra behind our recommendation for routine physical exams, labwork, imaging tests, and screening tests. We want to perform these check-ups when patients are well in order to detect risk factors prior to the development of significant disease.
There’s a great deal of evidence to support the benefit of preventative medicine for people. One study indicated over half of the deaths in the United States in the year 2000 were due to preventable “behaviors and exposures.” This included deaths from cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and infectious diseases.
It would seem, therefore, preventative medicine would be our best defense against illness. Yet, nary a few months go by before another study is published indicating preventative exams, lab tests, or diagnostic procedures are no longer being recommended as they provide no apparent benefit to patients.
As an example, the results of a recent meta-analysis of 52 different studies indicated annual pelvic exams were “unnecessary” for women. Results showed the exams provided no benefit for diagnosing women with ovarian cancer, uterine cancer, or vaginal infections early enough to save a woman’s life or preserve her fertility.
When I heard the results on our local news station early one morning, I immediately reacted with anxiety, anger, and concern, shouting irrationally at the television screen, while my husband stood bewildered at my outburst. When the media puts forth such medical information without a supporting net for the fallout, I can’t help but bristle in response.
When you examine the “bones” of the study, the American College of Physicians essentially is saying, skip the pelvic exam, but you still need to routinely test for cervical cancer. Though the conclusion I read was, “You still need to see your doctor regularly for preventative testing”, the media’s take was skewed towards, “Skip the exam and question your doctor if they suggest performing one.”
My first concern was women would hear the results and interpret them to mean, “You don’t need to make an appointments for an annual exam anymore – it doesn’t do anything.”
I then wondered how the perception of the results of such studies translated to veterinary medicine. If the (inaccurate) message put forth is preventative care is unnecessary and unhelpful for people, how can veterinarians ever attempt to convince owners of the importance of preventative health care for animals?
I am certain one of the main reasons we are unable to cure the majority of our veterinary cancer patients is because we diagnose and initiate treatment when their disease burden is large.
Animals are hard-wired to hide signs of illness or pain, and will often only just begin to give an indication they are sick only after their disease is quite advanced. Even the most astute and loving pet owner can easily miss the very early signs of disease.
Regular physical exams and a better ability to screen patients for risk factors indicating predispositions to cancers would lead to earlier diagnosis and a better chance for cure. We could also test breeding animals for susceptibilities to cancers and remove them from programs.
Prevention of disease could ultimately be less costly than diagnostics and treatment instituted at advanced stages. A 2007 study by the American Veterinary Medical Association (www.avma.org) supports this concern.
This study showed that although there was a consistent rise in spending on veterinary care for pets over a 5-year period, the actual number of veterinary visits per pet during that same time frame declined. Many interpreted the results to mean that owners were spending more money only once their pets were sick, rather than on their routine visits that could have prevented the larger expenses in the long run.
Lastly, bringing pets in for more wellness exams it will force veterinarians to place more emphasis on the lost art of the physical exam. On of my best mentors in veterinary school drilled into students that 90% of success in obtaining a diagnosis comes from the history given by the pet owner and the physical exam. Despite this, veterinarians consistently seem to rely much more significantly on the results of labwork or imaging tests to tell them what’s wrong with pets.
Think about it this way: If one year in the life of your pet equals seven years of your own life, and you skip your pet’s yearly checkup, it’s the equivalence of missing seven years of preventative care for yourself.
Imagine not going to the doctor or dentist for seven years. Would you not be surprised to learn you had “issues” with high blood pressure, were slowly gaining weight, or had a “bit” of dental disease at that time? How then can anyone be surprised when diseases are detected at such advanced stages in pets when routine care is avoided? And how can we be surprised when treatment options are limited and cure rates are low?
Keep up with the wellness visits for your pets – they really are an invaluable aspect of their overall health! And you may just be able to afford your companion with a chance for a cure they would not have had if you waited until they were actually sick from their disease.