James W. Mold, MD, MPH; Darren A. DeWalt, MD, MPH; F. Daniel Duffy, MD
Corresponding Author: James W. Mold, MD, MPH; George Lynn Cross Emeritus Professor of Family and Preventive Medicine - University of Oklahoma Health Sciences Center. Email: jameswmold@gmail.com.
Section: Family Medicine and the Health Care System
Publication Date: TBD
Prevention does not fit well within our problem-oriented medical paradigm, in which the focus is on curing or ameliorating existing diseases. It is easier and more satisfying to solve existing problems than it is to advise and motivate patients to implement measures to prevent future problems that may or may not occur. Clinician motivation is further diminished by the time required to help people make lifestyle changes, the low reimbursement rate, and the fact that the benefits, if any, are often not apparent for years. Typical patient panel sizes make it difficult to provide all of the recommended disease-oriented preventive services and to also address the social and lifestyle factors that can impact future health problems.
A potential solution to this square peg - round hole problem is to shift the focus from problem-prevention to goal achievement. Focusing on goals that are meaningful to patients, being able to enjoy valued activities and relationships for as long as possible, rather than on preventing specific diseases, could enhance motivation and commitment. A goal-orientation would also reveal the importance of prioritization, which, when facilitated by patient self-administered risk appraisal, could increase the impact of prevention visits. Individual risk assessment and prioritization would require periodic reviews of the full range of preventive strategies from social determinants through chronic disease management. Ongoing support for behavior change could be facilitated by individualizable clinical care pathways or ambulatory prevention centers.