McCormick W C, Inui T S
Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine and Public Health, Seattle.
Clin Geriatr Med. 1992 Feb;8(1):215-28.
Counseling patients in preventive health measures may be considerably more difficult for the clinician than managing acute illnesses. It requires medical knowledge and assiduousness on the part of both patient and physician, facilitative systems, the cooperation of significant others, and longitudinal good communication between all of these persons to facilitate the kind of objective-setting necessary to make preventive medicine work. The spectrum of clinical preventive care for the elderly is considerable, and the breadth of communication competencies required for optimal effectiveness somewhat daunting. All are within the scope of activities of the active clinician, however, given time and reflective experience. In this broad domain, what is most important to elderly patients may not be primary prevention (avoidance of onset of new diseases) but tertiary prevention (avoidance of impaired function from diseases already in existence) and avoidance of iatrogenesis. Ironically, the final acts of geriatric clinical prevention are those designed to assure appropriate end-of-life care.
对临床医生而言，向患者提供预防性健康措施方面的咨询可能比治疗急性疾病要困难得多。这需要医学知识，患者和医生都要勤勉，需要有促进性的系统，重要他人的配合，以及所有这些人之间长期良好的沟通，以促成使预防医学发挥作用所必需的目标设定。老年人临床预防保健的范围相当广泛，要达到最佳效果所需的沟通能力的广度也有些令人望而生畏。然而，只要有时间和反思经验，所有这些都在积极的临床医生的活动范围内。在这个广泛的领域中，对老年患者最重要的可能不是一级预防（避免新疾病的发生），而是三级预防（避免已有疾病导致的功能受损）以及避免医源性疾病。具有讽刺意味的是，老年临床预防的最后行为是那些旨在确保提供适当临终关怀的行为。
