Prevention is in the Eye of the Beholder
I saw a new patient the other day for a physical. No complaints, he said. He was very healthy, he said. Wellness was very important to him, he said. He was interested in being as proactive as possible about his health.
Wonderful! What more could a primary physician ask for than a healthy patient interested in being proactive about wellness?
I begin by taking a complete medical history and performing a physical examination.
Any medical conditions? No.
Ever been operated on for anything? No.
Allergic to any medicine? No.
Family history? Nothing.
Do you smoke cigarettes? Yes.
Wait, what? Health; wellness; prevention; smoker??
You will all be very proud to hear that I was in fact able to keep a straight face.
Next up is the physical, which begins with the measurement of vital signs:
Weight: 210 lbs.
Height: 67 inches
Body Mass index: 32.9
Temperature: 98.7, orally
Blood pressure: 160/100
Remainder of physical examination was completely unremarkable.
Okey doke. So what we have here is an obese smoker with an elevated blood pressure. My proactive wellness recommendations would be to stop smoking, begin an exercise program, and lose weight with a reduced-calorie diet.
It turns out that what the patient's idea of proactive wellness is a chest x-ray and an EKG.
Yes, he's aware that smoking increases his risk for lung cancer, which is why he wants the chest x-ray. This kind of makes sense (not really) but the mind-boggling thing is that he doesn't want to quit smoking.
I try to wrap my mind around this illogic (it's tough when one's brain is trying to ooze out through one's ears) and turn to the other major cardiovascular risk factor I have identified: his elevated blood pressure.
Yes, he knows that high blood pressure can lead to a heart attack. This is why he wants the EKG. No, he has no chest pain, shortness of breath, exercise intolerance, or any other acute symptom of coronary insufficiency at this time. And no, he is not particularly interested in changing his diet or exercise habits; and he doesn't think he'd be willing to take any medicine for his blood pressure (if it's still high after two more readings). He just wants the EKG. Because he's so proactive about wellness.
See what I'm up against?