Preventative Care: What Took So Long?

A shocking thing happened at the doctor’s office the other day, and I’m not talking about the unicorn at the reception desk; she’s been there for a while, and I personally absolutely support unicorn equality. I don’t think they should be discriminated against just because they have a tendency to leave a trail of sparkles everywhere they go, you know? They’re just born that way. Nor was I shocked by the utter dysfunctionality of the supposedly efficient and time-saving electronic medical records system; nothing new there either, and I’m dying (perhaps literally)  to see a medical office where such a system actually works.

No, what surprised me was that while I was going for a specific complaint, I actually got a comprehensive examination and we had a discussion about preventative care. This is something basically unheard of in US healthcare, and it’s something I’ve ranted about before; this country seems determined to fix things after they break, rather than identifying risk factors and preventing health care problems.

The thing is, preventative care is so cost-effective. It’s far less expensive to offer comprehensive examinations, basic health screening, and more in-depth preventative screening as needed depending on the patient than it is to wait for a patient to get seriously ill and then seek treatment. Preventative care could be saving patients a substantial amount of money, along with the government and insurance companies, and this should be a pretty profound consideration in a country with skyrocketing health costs. Yet, the US was historically resistant to preventative care, determined to force people to tough it out.

Of course, there’s another reason preventative care is a really good idea: it can prevent a lot of suffering. If an issue is prevented altogether or caught early, patients might tick a lot of economic boxes including spending less on treatment and being less likely to miss work, but they will also feel better and experience better quality of life. This is something that the nation hasn’t seemed to be very interested in, despite claiming that the United States is the best place on Earth and everyone who lives here experiences great quality of life.

The fact is that we don’t, and that our health definitely plays a role in that. Without access to preventative care, people get sick, and they suffer, and they often suffer needlessly because they’re forced to wait for care. And that is a bad thing; not just economically, but ethically. That alone should have been grounds for comprehensive preventative care recommendations to use across the US. Clinicians should have been allowed to practice basic preventative care with their patients without interference, denial of insurance claims, and other obstacles. Because it was, simply put, the right thing to do.

But instead, they were forced to parcel out care piecemeal, limited by a system that focused on the ‘bottom line,’ without any recognition that there was a better and cheaper way to do things. I always found this deeply puzzling, but also intensely frustrating as a patient seeking preventative care; clinicians never seemed to know quite what to do, didn’t have a guide to use in evaluations, didn’t provide the care I needed. Thus, I had situations like constantly unmanaged asthma, because my asthma would slip through the cracks until it got bad enough that it obviously needed attention and we had to start all over again with trying to get it under control.

That cost me more money, wasted a lot of clinician time, and caused me a lot of suffering. Waking up in the middle of the night unable to breathe is terrifying. Having trouble keeping up with friends when you take a walk on the headlands because you’re struggling to get enough oxygen interferes with your quality of life. Knowing that you have to restrict your activities because of your health condition without being able to get comprehensive care for that condition is infuriating. Yet, no one seemed to be able to agree on the preventative care I needed, the frequency of routine exams and evaluations, the steps I could take to control my asthma more effectively.

Now, these attitudes are finally starting to shift. The US may be heading on the right track in terms of promoting preventative care first and saving both money and suffering in the long term. Professional organisations are developing guidelines for care providers and physicians are talking about how to serve their patients more effectively, and how to make the best use of their time and skills. The health care system in the US is so very broken that at times I think it needs to be totally torn apart and put back together, but this is an important thing to implement even if it doesn’t fix larger issues.

It’s a step that indicates there is at least some commitment to actually considering the welfare of people in the United States as individuals, not just statistics. Sure, preventative care saves money and that was what ultimately drove the widespread push towards adoption of preventative care measures, but there’s something more than that going on here. Because a lot of care providers don’t consider economics in patient care, and they’re on the front lines of the preventative care movement, working to get their patients the care they need; their concern here isn’t money, but patient experiences. They’re the ones writing the guidelines, consulting with government agencies responsible for setting health care policy, and they’re the ones talking about how preventative care is designed, as its name implies, to prevent.

Not just to prevent cost overruns, but to prevent needless suffering.