Ounce of Prevention Worth a Pound of Cure?: When No Prevention and No Cure

“An ounce of prevention is worth a pound of cure” so the saying goes. But what happens when there is no means of prevention and there is no effective or permanent cure? In the worldview, I can think of war as one example. In the view of clinical medicine, I can think illnesses of today, which include some degenerative or inflammatory diseases and cancers or isolated symptoms of fatigue or pain as examples where the mechanism of onset is unknown and therefore prevention is unclear and there is no treatment towards an effective cure. As with war, we are committed to simply, for our time being, “live with it.” But how do we do that? And as physicians, what is our role and duty when currently prevention and cure is impossible?

It is important that all students as they learn to be physicians realize that despite all the science they are taught and all the medical gadgetry and procedures that are available, they are going to be faced with patients with such diseases as I described. This may be a hard realization to accept but surely this will repeatedly happen in their careers. The concept that the students must learn is that the role of physicians is not only to prevent and cure disease but to be responsible for ongoing support of the ill patient even with no probability of doing something curative. This is the very hard and frustrating part of being a patient’s physician, particularly if the doctor and patient’s goals are for a cure.

In this kind of illness, the approach should be one of changing the emphasis of the goal to support and attempt at comfort rather than cure and yet not abandoning hope. If this is done well and the patient is comfortable, this treatment can be almost as rewarding to the doctor as a cure.

The burden which the physician needs to realize that he or she may have to bear is that of “living with” the patient’s illness. And “living with” a number of patient’s illnesses is to some physicians intolerable and leads to annoyance with the person as a patient, delaying of patient visits or the transfer of the patient to care of another physician. Hopefully, the hospice concept, the education of physicians with regard to chronic illness, chronic physical and mental disability, pain management and comfort care, there will come a day when “no prevention” and “no cure” will become "no problem”. ..Maurice.