Is it the end of the disease era ?
Health problems related to an aging population are not well suited to a medecine based on diagnosis and treatment of individual diseases and maybe this kind of treatment is at best out of date and at worst harmful. In a scientific paper published in 2004, doctors Mary Tinetti and Terri Fried demonstrate how to explore those issues.
At the turn of the nineteenth century, while life expentancy was 47 years, and throughout the twentieth century, diagnosis of acute diseases became the focus of Western medicine. Meanwhile, as the twenty-first century promises life expectancy over 74 years, we are in a totally different medical practice.
Compared with acute diseases, chronic diseases have a spectrum of clinical manifestations much more extensive, not to mention that the correlation between symptoms and diseases is rarely clear. In fact, when you end up with patients who consume 15 different medications every day, diagnosis based on acute diseases are not the key to treat patients.
This primary focus on acute diseases can inadvertently leads to three unwanted effects:
- Undertreatment. The reluctance to treat patients who do not meet currently established and accepted diagnostic criteria.
- Overtreatment. The emphasis on screening inevitably leads to a growing supply of treatments.
- Inappropriate treatment or iatrogenic. Clinical decisions based on an acute diseases while not taking into account the patient overall condition.
The problem is not simple, and it deserves to be highlighted. Here we speak not only of health but also patient’s expectations in relation to what he really wants to live. Perhaps we need a more inclusive health model that takes into account all aspects of an individual’s life: socioeconomic factors, personal values, cultural values, education, lifestyle, etc.
In this video Mary Tinetti explains how to address geriatric problems.
© Pierre Fraser, 2011
