Historical reflections on current preventive practice.

Abstract

BACKGROUND: Preventive care in medicine and public health has evolved through historical stages. Recently, developments within the contemporary health care environment have pressured primary care physicians to deliver more preventive care, but little was known about the actual delivery of such services. The Direct Observation of Primary Care study investigated the delivery of preventive services. METHODS: In the study's qualitative portion, research nurses observed 138 family physicians in northeast Ohio, dictating observational fieldnotes. After transcription, the fieldnotes were content analyzed to identify patterns and themes. Further consideration led to a secondary historical analysis of ideas influencing medicine and public health. Fieldnotes were then re-analyzed from a historical perspective. RESULTS: The primary analysis showed variations among physician's philosophies and styles of practice that influenced the delivery of preventive services. The secondary analysis highlighted competing historical ideas that have shaped medicine and public health. The authors argue that contemporary physician's philosophies and styles of practice have parallels in the history of ideas informing medical and public health practice. CONCLUSIONS: The implications of these findings, particularly a lost appreciation of ideas that continue to be operational in practice, may be important if there is to be improvement in the delivery of preventive services.