[Healthy life style. Perspectives of prevention in modern society].

Abstract

Clinical prevention is defined as the application of all individual practice contacts of patients and physicians during the screening after risky habits or living conditions for the following specific consultation (i.e., aiming for "free of tobacco") and/or induction of specific interventions (i.e., medical check-up, health examination, immunization). All data available up to now are demonstrating that the theoretically accessible options for clinical prevention are realized merely imperfectly by physicians and/or are hardly accepted by the patients. This may be due to the restricted perception and clarification of three problem areas; they are separately discussed: 1. The clinical prevention is also part of a comprehensive "prevention politic" and needs adequate general conditions. I.e., it is generally unclear, who is supposed to take care of the health promotion and prevention: the government with its public health services, the health insurances, the society of panel physicians? 2. Clinical prevention is more distant to a strict outcome orientation than other medical areas. There is a lack of a firm proof of its individual, epidemiological, cultural, and economical effects - namely the positive and negative ones. 3. (Clinical) prevention is especially exposed to ethical tensions. The protection of the patient's (or the client's) autonomy plays a particular role. If it is possible 1. to reduce the fear of physicians and patients for the political implications of clinical and medical prevention more than in the past, 2. to work out and distribute convincing empirical proofs of the desired (and undesired) effects of prevention, and 3. to discuss the ethical tensions typical of prevention as well as to reduce them in each single case, the program of clinical prevention would have a real chance in Germany. Otherwise it has to be feared that there will only be "Medical Prevention Weeks".