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Birtwhistle and team from the Canadian Task Force on Preventive Health Care provide an excellent review of the (lack of) evidence that the traditional routine annual checkup decreases mortality in asymptomatic patients (1). They propose attractive alternatives to organizing preventive services.
I'm not sure, however, how much we can improve the landscape by redesigning one of the silos.It's surely true that medicine is weighed down by the baggage of unproven interventions and unnecessary practices. Many waste time and resources, some harm patients, all rob us of opportunities to make care – and patients – better. This is true even for preventive care.
In theory there is no difference between theory and practice, but in practice there is. In family practice, there is no such thing as the asymptomatic patient, certainly not for people in middle age or beyond. Even fewer have no targeted risk factors.
I have never seen a patient with hypertension or at risk for a cardiovascular event. I have seen Mrs. Jones with hypertension and diabetes and vaginitis and depression and unknown lipid values and a teenager on drugs. I have also seen Mr. Gomez, Miss Anderson and little Timmy. All were individuals, not diseases, interventions or outcomes.
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The Canadian Task Force on Preventive Health Care and the United States Preventive Services Task Force have pioneered and refined scientific methods for evaluating the evidence to support recommenda...Competing Interests: None declared.