Preventive medicine is a recognized medical specialty focused on the health of individuals and populations — promoting health and preventing disease, disability, and premature death.
We need to shift healthcare from reactive and treatment-based toward prevention. Most people agree with that. So why isn't it happening?
Plenty of people say it's the doctors' fault — that they don't care, or won't put in the effort. Others blame pharmaceutical companies, insurers, or business in general. The story is always the same: the public gets the short end of the stick and can do nothing about it.
I'm not so sure. Business exists to meet demand, and a lot of us are sick or injured and want help. Industry responds to that. If the demand for drugs and procedures dropped, the supply would follow. That is an uncomfortable thought, but it puts some of the leverage back where we can actually use it.
Here is a story from my practice that shows why things are the way they are. Larry is not a real patient. He is a composite of many people I have seen.
Larry is in his mid-forties, married, two kids, works a desk job. He was referred to me for knee pain and brought an MRI with him. After examining him and reviewing the imaging, I did not find a structural problem inside the joint that explained his pain. What I did find was a leg that was weak and poorly conditioned, with the kind of hip and thigh strength deficits that commonly show up in people with pain around the kneecap.
A word on how confident I am about that. Strengthening the quadriceps and hip muscles is well supported for this kind of knee pain. The older explanation — that one specific muscle is out of balance with another and drags the kneecap off track — is far shakier than it is usually presented, and I would not sell it to you as fact. What was not in doubt was that Larry's leg needed to get stronger.
I told him he needed to train consistently, three or four times a week, and that meaningful change would take four to six months. I told him it would not be easy and that he would likely have some discomfort along the way. Knowing his background, I knew this was going to be a hard road.
Larry was inactive. He sat most of the day. He said he exercised sometimes; my read was that he did not do much. For someone in that position, starting is harder and staying with it is harder than it is for an athlete who is used to working through discomfort. I could not be there for every session. He told me he could not afford physiotherapy, and even with a physiotherapist he would still have to do the work on his own most days. You can see where this is going.
Three months later he came back. Things were going OK, he said. He had been doing the exercises, sort of. He felt a bit better but still had pain, and he was sure something was wrong. I told him to keep going. He agreed and off he went.
Three months after that: "Doc, I'm slowly getting better, slowly getting stronger, but the pain is still there. Less, but still there." He was frustrated. He asked for another MRI. Then he asked for surgery.
He was progressing — just slowly, and partial effort makes it slower still. That was not what he wanted to hear. He wanted the procedure.
I did not operate. Surgery treats a structural problem, and Larry did not have one. Opening a knee that does not need opening hands a patient a surgical recovery on top of the problem they walked in with, and leaves the original problem exactly where it was. So I said no, explained why, and told him the door was open whenever he wanted to keep working at it. I don't know whether he went looking for someone who would say yes.
This happens constantly. If it isn't a knee, it's a shoulder or a back. Sometimes people never come back after the first visit — they decide I can't help and go looking for something faster. The fix usually isn't complicated. It just takes more time and effort than most people can stand.
Do I blame Larry? No. We are all trained, every day, to expect immediate results. Want a different show? Press a button. Want to know how to make cookies? Search it. Want a book that's out of stock? It arrives tomorrow. Your knee hurts? That may take six months to a year of difficult and sometimes uncomfortable work, depending on your circumstances and how much you put in. See the disconnect?
Add to that how many people have never been taught to move well. Asking someone to run their own rehab program — exercises that are hard and sometimes painful — when nobody ever taught them the basics is like asking someone to build a table when they don't know where to get the wood. It's still the best option available. It just isn't a fair ask without support.
Now multiply that by the number of patients a doctor sees every month with a version of the same problem, and it gets easier to understand why medication and procedures get offered early. I'm not defending that. I'm explaining it.
Can we do better? I think so. Here is where I would start.
- Health education and physical literacy should matter to us as much as reading and writing. They are often the first thing cut when school budgets shrink. That has to stop.
- We need to build more movement into the ordinary day. Long stretches of sitting — at work, in the car, at home — are consistently linked with worse health outcomes. The way we work and live has to change.
- We need to get our priorities straight about what matters. We value appearance and money and stuff. How you look matters far less than how you feel and what your body can still do.
- We need to teach children to work through adversity, mental and physical. Problems taking time to fix is normal. That is worth learning early.
- We need to keep doing things ourselves. Technology is fine. Outsourcing every physical and mental effort to it is not — capacity you don't use is capacity you lose.
Most of what we have built — how we eat, how we move, how we live — runs against what keeps a body healthy. Sitting all day isn't good for us. A diet built mostly on ultra-processed food isn't good for us. We do it anyway, year after year, because it is what fits.
Then, when the body has had enough and we get sick or injured, we expect to be fixed immediately. Sometimes the answer genuinely is medication or surgery. That's fine — those are real tools and we use them. Often it isn't. And when it isn't, the fix is slow. If you go looking for a fast one, someone will sell you a fast one. It will be a bandaid.
Staying healthy takes planning, effort, a willingness to be uncomfortable, attention to detail, and the understanding that this is a permanent change in how you live rather than a project with an end date.
I sigh a little when someone tells me they want to get "in shape," because it usually means "I want to look good without changing much." That kind of effort doesn't hold.
I'm a surgeon. I spend my days with people who are broken, and I know how and why they got that way. Working backwards from that tells you a fair amount about how to avoid ending up there. I can show you what to do. I'm telling you now that it won't be easy, and I can't promise you a particular result — bodies, histories, and circumstances differ.
We got into this together and we can get out of it together. Blaming doctors or drug companies won't protect your knee. Your effort will. Take charge of it.
If pain isn't settling, get properly assessed. What looks like a simple strength problem sometimes isn't, and the plan should be built around your actual exam rather than a general article. You can book an appointment with our team at Human 2.0 in Ottawa.
You can also find Dr. Chris Raynor on Instagram and Twitter.
0 comments