In itself, it means that an illness does not occur in the first place. Prevention is therefore an action strategy that serves to prevent a disease. Recognising diseases at an early stage is usually followed by early surgical or drug therapy, although this is not associated with a better outcome in terms of quality of life, symptom control, and life prognosis for all diseases. We should not forget this.
In addition, there is secondary and tertiary prevention, which is also not yet applied in a structured enough way in many healthcare systems. These programmes attempt to ensure that an illness does not get worse or does not come back.
Although it is an important goal, prevention still plays a secondary role in our society. The healthcare system continues to value and remunerate acute treatment more economically than a preventive strategy, which generally has more to do with dialogue, lifestyle issues, and less to do with medical equipment. This is about a holistic approach, which of course can only be realised in an interdisciplinary, interprofessional and cross-sectoral manner.
One example: a scientific and clinical focus at the Charité University Hospital is the Cancer Survivorship Clinic, a centre focused on the various aspects impacting long-term survivors after a cancer diagnosis. The centre looks at the needs of women diagnosed with uterine cancer, cervical cancer or ovarian cancer, which are given little attention in current routinary care, and also looks at their mental health, the bone system, cardiovascular status and the utilisation of preventive examinations. Unfortunately, this reveals a major deficit. At least 30 to 40 per cent of women had not had a skin cancer screening, bowel cancer screening or cardiovascular screening, for example. This clearly shows that the topic of prevention is not sufficiently present, although we all know that these women have an increased risk of osteoporosis, cardiovascular events and also secondary malignancies. Why is this the case? What needs to happen for this to improve?
Information and education for patients, relatives and medical staff are certainly important tools, but they also require a different structural framework.
Another reason could be that people don't like dealing with preventive care. It's all about nutrition, lifestyle, things like nicotine use, etc. It is perhaps too complicated, too unpleasant and too stressful for many people to address and tackle these sometimes chronic issues. These topics are also still not given enough attention in medical training and continuing medical education. But the other thing is the dysfunctionalities occuring in medical system. Many systems are still very sectoral and often too organ-specific. Precaution and prevention are cross-cutting issues and impact the very conceptualization of health for every clinical practice.
It is unusual for a doctor to talk about both bowel cancer and breast cancer screening. The gynaecologist talks more often about breast cancer or cervical cancer screening and the gastrointestinal specialist is more likely to mention bowel cancer screening. But the human body, our health, is one big whole, an interconnected system.
I would therefore like to see a comprehensive screening campaign. We need to work together across specialisms and professional groups. From the orthopaedist who looks after bone density; osteoporosis, for example, is known to be a huge societal problem. From the family doctor and general practitioner to the diabetologist and cancer specialist, everyone could work together to emphasise and inform about preventive care. Why not start campaigns that focus on preventive care for teeth, as well as cervical cancer and skin cancer? Aren't the influences of nutrition very similar for the cardiovascular system and underlying oncological diseases? And why don't we also address people's social environment, which we could motivate as a kind of joint prevention team?
That may sound ambitious at the moment. But I am certain that prevention must be viewed consistently and holistically. As specialists, we can't just look at our organ or a specific disease and make separate diagnoses. As a gynaecologist, I can also say: "Please pay attention to your dental hygiene, please watch your weight". A concrete example: Endometrial carcinoma increases the risk of dying from a heart attack or pulmonary embolism by a factor of 10 to 15. This means that I can't just deal with my speciality, such as endometrial cancer. I have to make offers that make sense in terms of health and, of course, not impose anything.
We must always realise that doctors are among the most important influencers when it comes to vaccinations or preventive care. What a physician says carries very special weight. We can utilise this opportunity. At the same time, we need to better reward preventive measures and interdisciplinary cooperation in the economic system. In "ancient" China, the rational supposedly went like this: "The less illness, the more the healer was paid. Today it's the other way round: the more illness, the higher the fee. There's something wrong with that, isn't there?
All medical professions can contribute to getting more people into preventive programmes. So why not set up prevention strategies across all professional groups? Initial examples report promising approaches.
Preventive care must therefore be a joint effort across all professional groups - this cannot be emphasised often enough. Another simple example: dental prophylaxis is not always carried out by dentists, but also by specially trained medical assistants. Those who bring people in for preventive care must be rewarded. A preventive consultation can have a billing code just like other important procedures. There are already codes for check-ups, but they are too limited and restricted. The doctor-patient conversation is also the key to the preventive care consultation in order to recognise the respective risk and initiate tailor-made preventive measures. And we know how poorly the consultation continues to be remunerated in our healthcare system - this must finally change!
If prevention is taken seriously, this service must be widely promoted and strengthened as a campaign. We are in the process of reorganising the healthcare system and it is absolutely clear that we are getting further and further into shortages and shortages - in fact, we are already in the middle of it. We will inevitably see more patients with diabetes, hypertension and cancer - due to lifestyle and the ageing of the population, not just in Europe, but worldwide!
We know that we don't get enough exercise and often have the wrong diet. So let's form a new alliance and a new trialogue: Prevention Care, Follow-Up Care, and Caring!