BMJ  2003;327:498-500 (30 August), doi:10.1136/bmj.327.7413.498

Education and debate

Is opportunistic disease prevention in the consultation ethically justifiable?

¹ Office of Human Resources, Landspitali University Hospital, IS-101 Reykjavík, Iceland, ² Department of Family Medicine, University of Iceland, Solvangur Health Centre, IS-220 Hafnarfjördur, Iceland, ³ Department of General Practice and Community Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway Irene Hetlevik

Medical resources are increasingly shifting from making patients better to preventing them from becoming ill. Genetic testing is likely to extend the list of conditions that can be screened for. Is it time to stop and consider whom we screen and how we approach it?

The first 150 words of the full text of this article appear below.

Most medical experts and health authorities consider consultations in primary health care ideal for opportunistic health promotion and disease prevention. Doctors are thus expected to discuss preventive measures even when they are not among the reasons for contact. But are such opportunistic initiatives ethically justifiable in contemporary Western medicine? We argue that doctors should maintain a clear focus on each patient's reasons for seeking help rather than be distracted by an increasing list of standardised preventive measures with unpredictable relevance to the individual.

The cornerstone of medical practice is the consultation between a patient who seeks help and a doctor whom the person trusts.¹ Several theoretical models have been developed to analyse and improve the quality of the consultation. In 1979, Stott and Davis presented an influential model that elicited four potentials of the encounter between patient and doctor: management of presenting problems, modification of help seeking behaviour, management of . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Personal or Public Health

Faye P Clark
bmj.com, 29 Aug 2003 [Full text]

Opportunistic Health Promotion in General Practice

Nigel C Stott
bmj.com, 1 Sep 2003 [Full text]

creep of medical surveillance

susanne McCabe
bmj.com, 2 Sep 2003 [Full text]

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