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Evidence-based approach to prevention

Suzanne W Fletcher, MD
Robert H Fletcher, MD, MSc
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
H Nancy Sokol, MD


Reproduced and adapted with permission from: Fletcher RH, Fletcher SW, Fletcher GS. Clinical Epidemiology: The Essentials, 5th Edition, Lippincott Williams & Wilkins, Philadelphia 2013. For more information, please visit www.lww.com.

If a patient asks a medical practitioner for help, the doctor does the best he can. He is not responsible for defects in medical knowledge. If, however, the practitioner initiates screening procedures, he is in a very different situation. He should have conclusive evidence that screening can alter the natural history of disease in a significant proportion of those screened.”

Archie Cochrane and Walter Holland, 1971

Most doctors are attracted to medicine because they look forward to curing disease. But all things considered, most people would prefer never to contract a disease in the first place—or, if they cannot avoid an illness, they prefer that it be caught early and stamped out before it causes them any harm. To accomplish this, people without specific complaints undergo interventions to identify and modify risk factors to avoid the onset of disease or to find disease early in its course so that early treatment prevents illness. When these interventions take place in clinical practice, the activity is referred to as preventive care.

Preventive care constitutes a large portion of clinical practice [1]. Physicians should understand its conceptual basis and content. They should be prepared to answer questions from patients such as, “How much exercise do I need, Doctor?” or “I heard that a study showed antioxidants were not helpful in preventing heart disease. What do you think?” or “There was a newspaper ad for a calcium scan. Do you think I should get one?”


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Literature review current through: Sep 2016. | This topic last updated: Jul 29, 2015.
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