Bioethics Discussion Blog: Ounce of Prevention Worth a Pound of Cure?: When No Prevention and No Cure

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Sunday, January 15, 2006

Ounce of Prevention Worth a Pound of Cure?: When No Prevention and No Cure

“An ounce of prevention is worth a pound of cure” so the saying goes. But what happens when there is no means of prevention and there is no effective or permanent cure? In the worldview, I can think of war as one example. In the view of clinical medicine, I can think illnesses of today, which include some degenerative or inflammatory diseases and cancers or isolated symptoms of fatigue or pain as examples where the mechanism of onset is unknown and therefore prevention is unclear and there is no treatment towards an effective cure. As with war, we are committed to simply, for our time being, “live with it.” But how do we do that? And as physicians, what is our role and duty when currently prevention and cure is impossible?

It is important that all students as they learn to be physicians realize that despite all the science they are taught and all the medical gadgetry and procedures that are available, they are going to be faced with patients with such diseases as I described. This may be a hard realization to accept but surely this will repeatedly happen in their careers. The concept that the students must learn is that the role of physicians is not only to prevent and cure disease but to be responsible for ongoing support of the ill patient even with no probability of doing something curative. This is the very hard and frustrating part of being a patient’s physician, particularly if the doctor and patient’s goals are for a cure.

In this kind of illness, the approach should be one of changing the emphasis of the goal to support and attempt at comfort rather than cure and yet not abandoning hope. If this is done well and the patient is comfortable, this treatment can be almost as rewarding to the doctor as a cure.

The burden which the physician needs to realize that he or she may have to bear is that of “living with” the patient’s illness. And “living with” a number of patient’s illnesses is to some physicians intolerable and leads to annoyance with the person as a patient, delaying of patient visits or the transfer of the patient to care of another physician. Hopefully, the hospice concept, the education of physicians with regard to chronic illness, chronic physical and mental disability, pain management and comfort care, there will come a day when “no prevention” and “no cure” will become "no problem”. ..Maurice.

3 Comments:

At Monday, January 16, 2006 1:18:00 PM, Anonymous Moof said...

Hopefully, the hospice concept, the education of physicians with regard to chronic illness, chronic physical and mental disability, pain management and comfort care, there will come a day when “no prevention” and “no cure” will become "no problem”

This last post has been quite revealing to me, as person with a chronic, incurable illness. It's caused me to see my physicians - and myself - in a completely different manner. Some of these thoughts had never occurred to me before, and frankly, I find them somewhat uncomfortable.

Does a physician see personal professional failure when they encounter a chronic illness? Surely there must be some feeling of having done well when they discover a chronic illness and halt or slow its progression, or when they can lend some comfort to a person who is in pain, and will never recover?

I would think that even an oncologist would feel "successful" although many of his patients die - because he manages to come in at whatever stage the disease has advanced to, and simply do his best from that point forward ... either to a remission, or if not, then to as comfortable a life as possible for whatever time remains.

... Dr. Bernstein ... do physicians have a Messianic complex?

.

 
At Monday, January 16, 2006 2:09:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, this is my impression that there are some physicians whose view of their role and their behavior would support your concerns. This impression comes to me from two sources. One is from talking with patients who have come to me from other physicians. The other is my experience in teaching in medical school for the past 20 years. Students are primarily taught the information and skills to make a diagnosis and how to treat the specific illness. They have their closest relationhip with patients who are hospitalized and therefore are in a usually very short term involvement in an acute process involving management of symptoms. Students also may participate in outpatient clinics allowing them briefly to see patients handle their ongoing chronic symptoms. Unfortunately, the student rotations may not permit long term followup. All of this denies the student practice in long-term attempt at control of specific patient symptoms.

It is really mainly when the physicians goes into practice with their own patients that they will experience the trials and tribulations of managing, on a longterm basis, those patients with uncurable chronic symptoms or diseases. If they haven't gotten the message by then that the physician's role is also chronic care of the patient and not only making a new diagnosis and treating it, then those will be the physicians with whom you may have concern. Maybe you or any patient can size up a doctor that you are visiting by asking him or her a single question: "Tell me Doctor, what would you do and how would you treat me if I had a disease or symptom that wouldn't go away or be finally cured?"
Listen carefully to how the doctor responds. That might give you a clue. ..Maurice.

 
At Tuesday, January 24, 2006 11:07:00 PM, Blogger Impatient Patient said...

Chronic Pain that is unremitting and incurable not only makes a doctor feel like a failure, but the patient, as they try everything that MIGHT be of value. Acupuncture TENS Excercise Relaxation therapy One on one Psychotherapy, Narcotics, Nerve Blocks, Vitamins, Diet Rest.....

Add to that the fact that they are treated as malingerers or psychosomatic morons, and things are a bit stressful.

Please encourage physicians to believe and support their patients as much as they can...This is NOT a life choice, but a real pain in the ass..........

 

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