Preventive guidelines

You tell ’em, Pimlott!¹ The only thing preventive care has ever done for me is engender guilt every time one of my patients gets sick. We family physicians spend hours a day counseling patients about osteoporosis and prostate cancer, while 80-year-old women with progressive heart failure get rushed to emergency departments because we’re too busy to make the preventive housecall. Ditto for our patients with cancer, dementia, and advanced diabetes. At some point, society needs to decide how we will care for those with advanced (terminal) disease. Home care requires doctors to make housecalls. Hospital care means long waits in the emergency room, with even longer waits for a bed, and a new set of doctors every time the symptoms recur and readmission is needed. Questionable preventive maneuvers and an office-based practice or care of the sick outside of methicillin-resistant Staphylococcus aureus infected hospitals? If sick yourself, what would you wish for?