What does preventative health mean to you?

Preventative health means empowering people to make changes to their own lifestyle which will prevent the onset, or reduce complications of, disease and illness with the aim of improving longevity and, more importantly, an enjoyable quality of life. It is different to screening which means testing for presence of early disease in people that may not have symptoms of it yet.

Prevention really is better than cure. Traditional medicine involves lots of crisis management as people present with symptoms of an acute illness, or advance of a chronic illness to the extent that symptoms can’t be ignored. If we look at chronic illnesses, such as heart disease presenting with a heart attack or severe lung disease presenting with critical breathlessness, although there are effective treatments to manage symptoms of these conditions, and improve quality of life for people, the damage has already been done. In those 2 situations that person’s heart will never be the exactly the same and the other person’s lungs are already irreversibly damaged. We have known for a long time that leading a healthy life reduces risks of many health problems and conversely poor choices lead to disease or worse outcomes. Preventative health means improving health literacy for people so that they can take charge of their own lifestyle and invest in a healthy future.

What do you recommend for people in their 20’s – 30’s (Gen Y, Z and Millennials)

Two things; first is to respect their futures selves by making healthy choices now and not waiting until it is too late. This means not smoking, getting plenty of regular exercise (we now know that after smoking, physical inactivity is the leading cause of heart disease), moderating alcohol intake, maintaining a healthy weight, becoming mentally resilient against modern stressors and many other things.

The second thing is to become health literate – this means to gain enough knowledge to sift through all the many sources of information on health out there and to be able to choose wisely those sources which are evidence based and credible. We live in a fast-paced, information-loaded world and, much more than 20 years ago when I graduated from medical school, young people can be persuaded by a catchy effective social media campaign more than high quality guidelines that can really help them.

What do you think about current Medicare preventative health initiates?

With the exception of Indigenous health checks which are encouraged throughout a person’s lifetime, these Medicare checks are good at screening people at risk being diagnosed with a chronic disease now, or older people that are more likely to have difficulties related to age. We know that the average age of diagnosis of diabetes, for instance, is in your 40’s. Therefore Medicare incentivise health checks for people in their 40’s. However, we also know that diabetes doesn’t happen over night and it is usually 7 years after their blood sugars start to rise that diagnosis is made, since it takes that long for symptoms to develop prompting presentation to a doctor. So waiting until they already have it at aged 43 isn’t as good as preventing it in the first place; the ideal would be to get them in their 30’s or even 20’s, to reduce their sugar intake, lose that weight and get the exercise and either prevent the diagnosis totally or push it back by decades.

What do you wish you were taught at school about preventative health?

Really, the dangers of not exercising and eating too much sugar – I mean, we knew it, but perhaps didn’t appreciate how damaging those poor choices can be. In terms of critically evaluating evidence, I was lucky since I choose science subjects and so this has been second nature to me, but I think that all kids ought to be taught how to verify the quality of advice they receive.

What educational resources would you recommend to people?

There are lots of good evidence-based guidelines published by various Australian and international organisations, but in order to engage young people I would advise an Aussie film called ‘That Sugar Film’ and for bookworms, ‘Sweet Poison’ by David Gillespie.

What would be involved in a preventative health check if a patient came to see you at The Barracks?

A health check will vary from person to person; obviously, health needs vary between age groups and also between men and women but are also influenced by a person’s past medical history, family history and individual health concerns, and these may change our focus somewhat.

For every patient we will be taking a full medical history, including what medications they may taking, asking about drug allergies, past medical problems and family history. We’ll also enquire about lifestyle factors that can influence health including smoking, alcohol and other drugs and about their occupation and homelife – knowing someone’s social situation such as type of dwelling or who they live with, or what job they do is always a factor and sometimes critical in their current and future risks for health problems. I also like to ask about people’s diet and their physical activity level and screen for mental health problems such as depression or anxiety.

A physical examination will then be performed including basic measurements such as blood pressure and pulse, height, weight and waist circumference and a quick examination of heart and lungs. Depending on circumstances we may then consider an ECG, spirometry, blood glucose measurement, urinalysis, a full skin examination and blood tests.

For every adult I discuss the need and if necessary, offer a skin check, with light skinned people, red heads, those with previous skin cancer in themselves or their family and people with multiple moles being at higher risk. In anyone if there is a new or changing mole or non-healing sore it ought to be assessed carefully.

Sexual health screens are commonly offered by us, and commonly requested by patients of all ages, since the stigma for sexual infections is much less than it used to be, and people are getting the message that early treatment of these is much better for them and the community.

For middle aged people I discuss the bowel cancer screening, which is currently advised for people over the age of 50, or sometimes younger in people with a strong family history.

For men I take the opportunity to ask about prostate symptoms and to determine if screening is needed, as well as educating on testicular health and reminding them that they are at an increased risk of some medical conditions such as heart disease.

For women over 25 I remind the importance of Cervical Cancer Screening and for women over 50 (over 40 in some cases) the importance of Breast Cancer Screening.

Once the initial assessment is complete, if the need for further testing has arisen, like blood tests, these are arranged, and the results given in a later visit. Depending on the final assessment we may decide on an early review or give the all-clear for a few years.