Prevention – A Great Specialty

By: Kevin Hanson, CAPT MC USN (FS) (Ret)

“An ounce of prevention is worth a pound of cure” is one of those expressions that pass the proverbial common sense test. It is somehow profoundly self-evident. Today, this simple theme is at the heart of fundamental change in the medical profession and the healthcare system. Powerful economic and public policy forces are completely re-orienting the way medicine is practiced in both the civilian and military worlds. We are consciously shifting our focus from illness to wellness. Though most doctor-patient encounters still revolve around diagnosis and treatment of an existing condition, preventive strategies such as screening, counseling, and immunization are being emphasized like never before. Physicians and healthcare organizations are now actually being evaluated on how well they provide preventive services, and how healthy they keep their patient populations. If you’re into the health part of healthcare, it is an exciting time to be entering the field of medicine.

Whether you become an internist, surgeon or virtually any other type of clinician, it is likely that prevention will play a significant role. However, many medical students (and physicians) are not aware that there is a specialty devoted entirely to prevention: Preventive Medicine. If you’ve never heard of this specialty, or you think it is an obscure backwater and not “real medicine,” read on.

Preventive Medicine (PM) has been recognized by the American Board of Medical Specialties since 1949. According to the American Board of Preventive Medicine (the certifying organization), “Preventive Medicine is that specialty of medical practice which focuses on the health of individuals and defined populations in order to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death.” The specialty has three separate disciplines: General Preventive Medicine, Occupational and Environmental Medicine, and Aerospace Medicine. For PM specialists in any of these fields, the “patient” is an entire population. The difference between traditional clinical specialties and PM is akin to the difference between tree surgery and forest management. Some of the interventions that will have the greatest impact on the health of people (or trees) require a population-based perspective. With today’s emphasis on wellness for entire populations, the specialty of PM is ‘just what the doctor ordered.’ Though all three PM specialty areas are fascinating fields with huge opportunities, the remainder of this article will focus on General Preventive Medicine (GPM) in the military.

Prevention in the Military

In military medicine, prevention is absolutely mission-critical. The medical officer’s main job, regardless of specialty, is to “preserve the fighting strength;” treating casualties is actually a secondary priority. Preventing disease and injury is a high- stakes challenge. Sick or injured soldiers, sailors, airmen and Marines can’t do their jobs and may compromise a unit’s ability to carry out its mission. Military operations, whether in combat, peacekeeping, or for humanitarian purposes, usually occur in areas of the world where the medical threat is very high. Malaria, dengue fever, epidemic diarrhea, heat injury, and toxic exposures are but a few of the potentially show-stopping threats with which we must contend. All are preventable, and every military physician is involved. However, there is a critical role for the special knowledge and skills of a PM physician. As one officer put it, “A kilo of prevention is worth a 50,000 ton field hospital. Most especially in the military, the specialty of PM fills the prescription.

There are a tremendous variety of jobs within the Army, Air Force and Navy / Marine Corps for residency trained PM physicians. They are key players in operational medicine, serving on senior military staffs orchestrating programs that protect the health of thousands of service members during routine training and overseas deployments. They also serve in regional military PM units overseas and in the U.S., carrying out functions analogous to the Centers for Disease Control (CDC), such as health promotion, disease surveillance, outbreak investigations, medical threat estimates, and operational planning. PM physicians run travel medicine clinics in various settings, and provide direct consultation to operational medicine clinicians for cases such as tuberculosis and HIV.

Prevention Physicians

PM physicians are also assigned to military hospitals, where they are uniquely qualified to apply sound cost-effectiveness and outcome measures to improve the efficiency and effectiveness of medical care. They serve in senior policy positions, on the staff of the Assistant Secretary of Defense, and military Surgeons General. In these settings, they have a significant influence on the policies that directly affect the health of the entire military as well as our beneficiaries. Military medical research labs in the U.S. and overseas also have PM physicians assigned. They participate in cutting edge work on vaccine trials and other critical research. They also have a central role in emerging infectious disease surveillance. There may be no other specialty that offers this degree of variety. The “fun-factor” is also exceptionally high.

Both in the civilian and military worlds, as medicine moves to the next century and fully integrates the population-based perspective, PM physicians will likely take on additional roles. The future is very bright.