Scholarship - Alberta Shortlist Chu Lin

Fear Tactics Have No Role in Preventive Medicine: 2019 Scholarship Finalist (AB)

Chu Lin

University of Alberta – Doctor of Medicine – 2021

Medical education places tremendous emphasis on risk factors for disease and illness, and this invariably translates into physicians’ efforts to persuade patients from avoiding any risk factors for disease. A common example of this is with physician efforts in promoting smoking cessation, with the message conveyed to patients typically being “Smoking is bad for you – it causes cancer.” Fear tactics like this are commonplace in medicine and extends beyond smoking and cancer. Another example can be seen with opioids, where the typical message is that it can cause addiction, overdose and death. These kinds of blanket statements rooted in fear tactics are not always true, because certainly not everyone who smokes or uses opioids would end up with the severe consequences that physicians have warned. And many patients can think of someone in their social circle where these consequences have never happened, thereby “invalidating” the physicians’ claims. As you can imagine, then, fear tactics are largely ineffective and can potentially lead to deteriorations in patient trust in the healthcare profession, which invalidates efforts to promote preventive medicine.

As a medical student, I hope to avoid fear tactics in my future practice of medicine. My goal is to understand individual patients and meet them where they are at, in hopes of appreciating the diverse reasons that compel them to make decisions. Patients do not need healthcare professionals to instruct them on the “right” way to live life, because the right way certainly does not exist. Similarly, patients do not need a healthcare professional to unilaterally prescribe them a plan or decision regarding their health, because ultimately it is up to the patient to deem what is important to them, and the route they wish to take to reach these goals. Now, that is not to say that physicians should never encourage risk reduction – it’s just that the way that physicians promote disease and harm prevention needs to be placed in the larger sphere of the patient’s way of life, and their psyche. This requires discussions and cooperative decision-making, and fear tactics have no place in this picture.

One of the ways that I’m embracing this approach to preventative health currently is through a medical student initiative I’m leading, entitled “Street Sense”. Our focus is on changing the culture of conversation we have around drugs in high schools. We know that the traditional message of “Drugs are harmful and must be avoided at all costs” is largely ineffective for the youth population, and that an abstinence-only approach does not resonate well in this demographic. Rather than relying on this kind of negativity-focused discussion, our initiative focuses on equipping youth with information they need, such that they can make decisions for themselves. This includes discussion about the risks and benefits of drug use, overdose recognition, and when to seek help. We also bring in local harm reduction agencies to teach students naloxone kit administration, a popular exercise among students. I want to make clear that we never endorse drug use, but the goal of the initiative is to meet students where they are at, such that youth can be as safe as possible as it relates to drug use. This is the kind of preventive medicine that I hope to be apart of in the future, the kind that is focused on patient strengths and what they can do, rather than focusing on patient deficits and what they cannot do.

In my opinion, preventive medicine is evolving to become more patient-centered. Gone are the days where healthcare teams prescribe patients with a plan they must follow without deviations. Evidence tells us that we need to make decisions with patients, and that we need to respect patients for whichever path they choose. Healthcare providers stand to support patients and provide help when appropriate, and there is no place for making judgments for patient choices and lifestyles. The future of preventive medicine is also focused on strengths, and not deficits of the individual patient. This is the kind of medicine that I hope to partake in as I enrich my medical training, and the kind of medicine that I had imagined when I started the journey.