Pim Assendelft, theme Healthcare Improvement Science, discusses the role of the physician in prevention in a recent issue of the Netherlands Journal of Medicine (‘NTVG’).
The role of prevention in medical care has recently been described and discussed in various strategy reports by Dutch medical professional organisations. However, there are still doubts concerning the effectiveness and feasibility of practicing preventive medicine. Both inconclusive evidence on its effectiveness, including on long-term outcomes of preventive medicine interventions, and studies showing positive results have been published. In general, more intensive approaches towards lifestyle change are more effective. Regarding disease-related prevention intervention, various authors stress that this is undoubtedly a task reserved for physicians. Their degree of responsibility and input is less clear when it comes to indicated and selective prevention. Nonetheless, for these latter types of prevention there seems to be a role reserved for the physician, given the increase in lifestyle-related chronic diseases and the prevalence of social class related health inequity. Here, the author argues that physicians are ideally positioned as advisor and motivator, especially towards more vulnerable patients. Preventive aftercare can then be organised in partnership with other providers. To take an active role in prevention still needs 'guts', and physicians are challenged to take a position in this.
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