Health Promotion at every stage of the game!

I never thought there’d be much room for primary prevention in a GIM setting, whether ambulatory or ward. My rationale was that the process of engaging patients in lifestyle modifications and health promotion strategies takes time. It often requires a longitudinal therapeutic relationship and multiple visits over years to truly reinforce these topics. However, today’s events in ambulatory care clinic challenged this notion.

My last consult of the morning was a “surprise”. My preceptor quickly prepared me by stating “the patient is a young gentleman and that’s all I know. Good luck!” Mr. A was a young male in his early 20s presenting after a recent asthma exacerbation. He was accompanied by his mom during the clinic visit. Mom stated that he had “grown out” of his childhood asthma and had been symptom-free for more than 15 years before his most recent exacerbation. Notwithstanding some recreational substance use, his past medical history was fairly unremarkable. However, he drank at least 3 beers every day in addition to ½ pack per day of tobacco and routine marijuana use.

As a healthy guy who rarely saw his family physician, this recent episode of respiratory distress was particularly traumatic for him. He asked me a lot of questions about the progression of asthma and how to prevent future attacks. I spent the majority of our appointment counseling him on many aspects of primary care including the importance of smoking cessation, annual flu shots, proper inhaler techniques, and low-risk drinking guidelines. Mr. A seemed particularly engaged, probing me on medications to help him quit smoking and asking me about other inhaler delivery methods which might improve his compliance with the medications. As we hit upon each topic, it struck me how similar of a visit this might have compared to that in a family physician’s office. I’ve always thought of GIM as a tertiary subspecialty: a field where complex consults require expert eyes to examine a patient’s chart for a unifying diagnosis to help guide treatment. This visit challenged me to broaden my perspective on GIM as a holistic specialty dedicated to guiding patient care on many levels.

I envision my future career as a Family Physician but today’s lesson has helped me better understand the parallels between my area of interest and that of GIM. It’s reassuring to know another set of eyes is equally committed to engaging patients in preventative care.
-AX