Feasibility of opportunistic disease prevention

Editor—Getz et al doubt the justification for opportunistic disease prevention in primary care because the expanded agenda of risk and prevention since 1979 seems too daunting.¹ This is not logical. The correct course is good science and sound professional discipline in the interests of patient wellbeing.

A lot of relevant research has been conducted during the past 25 years and international acceptance of a broad approach to the consultation in primary care is based on this work. The fact that some patients (and doctors) prefer to limit themselves to presenting problems alone is not new; neither is the evidence for caution over how and when to raise wider clinical concerns with such patients.²,³ It has never been good science or sound ethics to impose screening tests or risk factors on patients in the absence of fully informed consent and the time and skills to intervene.^3-5

What has changed is far greater professional sensitivity to the importance of fully informed patient consent and an expanding evidence base about how best to achieve effective communication about the risks and benefits of screening tests and other clinical interventions.⁵ To abandon these advances because the agenda of possibilities is growing would turn our backs on the development of our discipline just as it is coming of age.

In an era of increasing specialty fragmentation, the case for a well-trained clinical generalist who maintains a broad view of the health needs of each patient has never been stronger.