Prevention Is Better Than Cure
By Dr. Anupama Gotimukula, Dr. Joseph M. Chalil
Advika was in her late forties. Despite feeling tired and noting some abnormal pains during her monthly cycle, she declined to go to the doctor. The cost of traveling to the doctor was expensive and she didn’t have the extra funds or time to take a day off work for the trip. Eventually, she started feeling so bad that working was almost impossible. Finally, she went to the doctor, only to find out that she had an advanced stage of cervical cancer.
While we would all wish that her story was rare, the truth is that undiagnosed cancer happens frequently in India. Advanced stages of cancer are less likely to be cured and have a greater chance of relapse. In stage one, for instance, the cure rate is around 85% but that number falls dramatically for those in stage 3. Cancer patients who are diagnosed with stage 4 cancer are not likely to survive for more than five years.
The World Health Organization says that cancer is diagnosed in more than 14 million people worldwide annually and ends up killing approximately 8.8 million. What is most shocking is that two-thirds of these deaths are in low-middle income countries where the diagnosis is found to be inadequate.
The Indian system of modern medicine does not promote an annual preventive physical exam for patients even though several private hospitals promote comprehensive executive checkups for the wealthy. It’s time to change that. Identifying chronic diseases like Diabetes, Hypertension, and heart diseases early and managing them is a lot more effective than managing and treating their complications.
In the United States, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services. “The Prevention TaskForce” application assists primary care clinicians to identify the screening, counseling, and preventive medication services that are appropriate for their patients. The government of India could implement a similar project and use the lessons learned in the United States and other countries.
If all patients in India have access to a complimentary annual preventive physical exam, including routine lab tests and cancer screenings, this will increase the chances of finding cancer and deadly diseases earlier and will enhance the likelihood of a cure. The cost to the taxpayers of India will eventually be far less as we prevent long-term complications of Cancer and Chronic Diseases.
For the individual patient who is covering the costs of seeing a doctor, the idea of an annual physical examination when they feel fine seems like a waste of financial resources. As has become the case in countries around the world, primary care and annual physical examinations are beginning to disappear. As telehealth and digital medicine options have continued to increase in use, particularly during the pandemic, the idea of a traditional physical exam has come under greater scrutiny. A combination of physical exams and telehealth might be the way of the future in keeping our nation healthy.
The annual physical exam is part of the larger discussion about primary care and whether it is necessary. In the U.S., India, and other countries around the world, medicine has become the way you manage the disease, not prevent it. Primary care, on the other hand, is a way to prevent disease by talking with patients about their potential health risks and giving them practical advice on how to care for their health, while considering their unique lifestyle challenges.
Unfortunately, there is little discussion about how focusing on primary care, including the annual physical exam, could positively impact the costs of healthcare. Far too often, individuals throughout the world find themselves waiting to seek medical attention until they are much sicker, simply because they do not have the funds to afford basic preventive primary care or may struggle to stick with prescribed preventive health measures and lifestyle changes due to costs or social status.
While telemedicine does offer a way for physicians to connect with their patients in a cost-effective manner, there is something to be said for having a patient in front of you, where you can physically examine them. When a patient disagrees with their doctor, for instance, having a physical exam can give you data that informs the discussion and could be helpful in getting the patient on board with the treatment options available.
A patient who might be looking for antibiotics to treat a respiratory infection might feel better about not needing medication when they know that their lungs are clear, and their oxygen saturation levels are within normal range.
Telehealth does offer a means for doctors to understand the home environment of their patients and give them the opportunity to connect more frequently with their patients throughout the year. Virtual visits can also respect the patient’s time, as well as the doctor’s. Plus, technology is continuing to improve the ways available for doctors to collect physical data from their patients without physically having them in the office.
End-stage renal diseases can be prevented by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure The costs for cancer treatments increase dramatically at later stages, as your medical team deals with cancer and its side effects. Families often see any cancer diagnosis as a huge financial blow, meaning that they are also willing to make choices between treatment and caring for family needs. Annual physical exams, which include routine tests and screenings, could be a way to save individuals and their loved ones the financial and emotional costs of cancers and many other preventable diseases.
How can we make this happen in an affordable way using digital technology platforms like Telehealth? India being a leader in digital technology- this can be implemented more efficiently and make healthcare more accessible to the common man especially in rural areas across the nation.
American Association of Physicians of Indian Origin (AAPI), the largest ethnic physician organization in the United States, representing over 100,000 Indian American Physicians, has initiated preventive healthcare screenings in 75 villages to understand the concept of preventive screenings help to diagnose any silent diseases which are causing premature deaths from Coronary heart disease and cancers like Breast cancer, cervical cancer which are preventable if diagnosed early through these annual screenings as mentioned above.
During the annual Global Healthcare Summit AAPI has planned to organize in India at Hotel AVASA in Hyderabad from January 5th to 7th, 2022, physician leaders from the United States and India will have an opportunity to brainstorm and explore ways to focus on the theme, “Transformation of Healthcare through Telehealth and Technology usage during this post-Covid Era” recommend possible ways to plan and implement preventive medicine that will save resources and precious human lives.
It’s our hope that the Government of India will appoint an expert panel of nationally recognized experts in the disciplines of preventive medicine and primary care, including internal medicine, family medicine, geriatrics, pediatrics, preventive medicine, behavioral medicine, public health, obstetrics, and gynecology, and nursing to create an Indian Preventive Task Force (IPTF) recommendations should be promoted and implemented as part of the Free annual physical exam or telemedicine visit at Government Hospitals and Primary care centers. Private hospitals and Insurance companies should be encouraged to provide Annual Physical exams or Telehealth visits, following IPTF recommendations for free or at affordable cost. Many of the routine lab tests, vaccinations, blood pressure checks, and some cancer screenings like self-breast examination can be done remotely and event at patient’s home with the help of Asha workers. The annual physical exam is a critical part of quality primary care and one that needs to be automatically covered as part of the Indian healthcare system.
To shift our healthcare from being disease and treatment-centered, we need to elevate the value of primary care, particularly the annual physical exam, and recognize how critical this is to have a healthy nation and a healthier world.
With one of the largest populations in the World, India could lead the World in providing quality health care to all its citizens and the recent COVID-19 vaccination drive is a great example. The biggest democracy in the World needs urgent Investment in the health of all its citizens and reform the public healthcare system.
*Dr. Anupama Gotimukula is the President of the American Association of Physicians of Indian Origin (AAPI), resides in San Antonio, TX. A board-certified Pediatric Anesthesiologist, practicing since 2007, Dr. Gotimukula is affiliated with Christus Santa Rosa, Baptist, and Methodist Healthcare systems in San Antonio.
*Prof. (Dr.) Joseph M. Chalil is an Adjunct Professor & Chair of the Complex Health Systems advisory board at Nova Southeastern University’s School of Business; Chairman of the Indo-American Press Club and The Universal News Network publisher. (He recently published a Best Seller Book – “Beyond the COVID-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare.”)
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