Improving preventive care

I am not surprised that we are missing opportunities for prevention in general internal medicine for inpatients. [1] General internal medicine patients are not admitted for preventive care. They are admitted because they are sick - often very sick, with multisystem involvement. Most are elderly, and many have been receiving other levels of care. The patients are often too ill to discuss prevention or have pre-existing cognitive problems that make such discussion impossible. They may have a burden of disease that makes most preventive manoeuvres unlikely to make a difference.

The demands are many, the time is short. In our current environment there is unrelenting pressure to move these patients through the system as fast as possible, to make way for the never-ending stream of patients entering the emergency department who also require admission to hospital.

Preventive medicine is difficult to practise and often of limited benefit in the general internal medicine ward setting. Where it should be improved is in the office setting, where circumstances are more conducive to discussion and a larger proportion of patients may benefit.

Dawna M. Gilchrist, MD

Department of Medicine; University of Alberta; Edmonton, Alta.