By: Tamzin Rosenwasser, M.D.
We hear much talk about preventive care, but nobody has defined it. From the content of the discussions, I deduce that what the health bureaucrats actually refer to would be better characterized as “early detection.” Early detection is what occurs when a physician finds a disease in its early stages that might have been prevented by earlier measures. But who can take those measures? Not the physician, only the patient. There is only one person living the patient’s life; it is the patient. I cannot live his life for him.
Let’s consider obesity, and intake of harmful substances. If I have a dog, I can control the dog’s life so that it takes in only whatever food I give it, and is protected from harmful substances. But as a physician, do I portion out my patients’ food daily? Of course not. Am I in charge of restricting their lives so they cannot have access to cigarettes, or too much booze? No.
Prevention lies entirely in the patient’s realm. All the physician can do is advise. Not even the most conscientious patient can prevent all disease and injury, and the physician can do nothing to prevent medical problems unless the patient is reduced to the equivalent of livestock or a ward of the state. Physicians do warn of problems that may arise if the patient does not take action to avert them. In my experience, very few of the patients who are counseled about the risks of smoking, excess alcohol, sun and tanning beds, sedentary lifestyle, unhealthy diets, and harmful drug use act on the advice. Some state that they will not do so, and many can be observed not to do so.
When I advise patients with melanoma, a skin cancer that can kill the patient, to use clothing as protection against UV radiation from sun, I have heard these responses: “I’ve only had one.” “We have a boat.” “Do you know how hard it is to wear long sleeves?”
I have seen college students step into the street without a glance in either direction, relying on the posted 5 mile-per-hour speed limit. The message they get is that someone else is responsible for their safety as pedestrians. Surely, every motorist should take utmost care to avoid injuring someone, but that job becomes more difficult if the other party abdicates responsibility for his or her own safety.
When government usurps responsibility, I suspect that people are more likely to abdicate. That has happened with Medicare and Medicaid. The taxpayers are stuck with paying for the medical care of strangers. People who don’t have to worry about the bills may be more willing to take the chance of getting skin cancer out on the golf course, or hepatitis C from IV drug abuse, or lung cancer from smoking, instead of using sunscreen and clothing, not abusing drugs, or quitting the smoking. Pride and shame leach out of their souls and they are quite comfortable with spending someone else’s money to care for problems they could have prevented with their own efforts.
One young smoker, whom I advised to quit, remarked: “By the time I get cancer, they’ll have a cure for it.” How nice that the universal “they” are working on this person’s behalf, while he lifts not a finger to help himself. People are developing a predatory dependency, like the ungainly cowbird, which lays its eggs in a warbler’s nest after kicking the warbler’s eggs out. The warbler ends up raising the young cowbirds, which tower over her like a six-foot man over a petite woman.
This dependency is part of the unconcern with preventive care if it takes any personal effort by the patient. Much of life is maintenance, including maintenance of one’s own health. Should the physician, and strangers, care more about someone than he is willing to care about himself? Where would this burden end?
The Founders of our nation constructed a Constitution, which is permanent because it takes into account an unchanging verity: human nature is immutable. The moral corruption that accompanies allowing one person to sponge off another is mirrored in biology. If a person is treated long enough with high enough doses of prednisone, his adrenal glands will stop making the equivalent steroid, and if the prednisone is stopped suddenly, the patient may die of adrenal crisis because the adrenal glands will not start working again quickly enough.
No society can be healthy when citizens refuse to take the steps necessary to keep themselves healthy. Physicians are doing what they can to detect disease early, but we cannot do the patients’ job of preventing problems arising from behavior such as smoking, excess drinking, dangerous drug use, violence, carelessness, sedentary lifestyle, poor diet, sexual promiscuity, and ultraviolet exposure.
If patients refuse to do the job of prevention, we can let them suffer the consequences themselves. Or we can force the entire society to suffer the consequence of total loss of liberty at the hands of a tyrannical government nanny. That is a price I am not willing to pay.
Dr. Tamzin Rosenwasser earned her MD from Washington University in St Louis. She is board-certified in Internal Medicine and Dermatology and has practiced Emergency Medicine and Dermatology. Dr. Rosenwasser served as President of the Association of American Physicians and Surgeons (AAPS) in 2007-2008 and is currently on the Board of Directors. She also serves as the chair of the Research Advisory Committee of the Newfoundland Club of America. As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.