The Case for Preventative Medicine

Keeping active in middle age

In a busy week, I’ll typically consult just under a hundred patients and the vast majority become part of the blur of working life.  Occasionally however, some stick in the mind.

In the late 2000s I was a partner in a busy Hackney practice.  While the majority of our population were socially and economically deprived, gentrification was coming and with its proximity to the City of London, we would occasionally see a very different type of patient. 

A young French woman attended, recently settled in London and new to the practice. And new to the NHS.  She presented with no medical problems but with a list of specialists that she wished to see – including a gynaecologist and a physiotherapist.  I explained that in the NHS, we only really treat with an identified problem.  Coming from France, she was used to regular, annual gynaecology assessments and pre-emptive physiotherapy – and she wanted these for free on the NHS.  I explained the primary care services we could offer but with no identified medical problems, any NHS referrals would have been inappropriate. She opted for private referrals but her deeply held expectations stood out.

Roll on 20 years, and increasingly there is a case for what is sometimes termed ‘Preventative Medicine’.  Primary Care manages health concerns where appropriate, without the need to refer to specialists, to avoid inappropriate investigations, health anxiety and of course to manage finite resources. 

As we age however, there is an inevitability about our physical progression.  We will go through puberty and in middle age, women will go through their perimenopause and menopause; men will go through their own physical changes, although I deliberately do not use the ‘Manopause’ to describe it. 

Busy lives and a busy NHS – together with an engrained culture of reactive medicine – mean that patients will typically present to me when they are experiencing the worst of their mid-life symptoms. In women, this can be the worst of the rigours of the menopause; in men it may be the lifestyle issues of weight gain, high blood pressure, poor sleep or sexual dysfunction.

The inevitability of mid-life conditions mean that they will happen, whether we like it or not.  With a reactive approach to medicine, I increasingly believe that we are missing the opportunity to plan for our mid-life, to be prepared.  Lifestyle articles abound and I would refer you to my Recommended Reading page for books that may help.  I believe that we should all take professional medical advice as we age and this should start with a visit to your GP.  A GP can advise you on what to expect and how to manage this change, adapting your lifestyle accordingly. 

While I have no first hand experience of the French health services, when it comes to Preventative Medicine, I think we may need to be a bit more French about our health.

Dr Katie Simpson

Specialist GP

August 2024