Do our patients receive maximum benefit from preventive care? A North American perspective.

Politicians, their constituents and family physicians believe that preventive medicine is essential if health care is to be improved. Family physicians believe that the majority of their patients are well cared for with preventive health care services but in reality preventive services are provided to less than half the population and some to fewer than 10%. Barriers to providing preventive care include the selection of procedures of unproven effectiveness, public unawareness of the benefits of the procedure and practical obstacles for physicians providing the services. Assessment of each of these barriers indicates how preventive care can be improved. Narrowing the gap between what we believe about preventive care and the level of preventive services we are providing could improve the health of our nations. However, the concept of primum non nocere must dominate the assessment of currently advocated preventive procedures and the consideration of new procedures.