Preventive medicine in practice: the state of the art.

Primary and secondary prevention, as opposed to tertiary prevention, is the logical approach to attack today's leading causes of premature death. To apply preventive medicine in their practices, physicians may use a number of tools. The traditional annual examination should be abandoned in favor of periodic screening of asymptomatic patients according to age and sex. Screening should be done on a case-finding basis, facilitated by use of a longitudinal screening flow sheet and evaluated by use of a retrospective audit. An age-sex register can help identify which patients belong to a high-risk group. Health hazard appraisal is a tool for estimating a patient's risk before and after prescribed preventive intervention, and may stimulate patient risk factor reduction-as may other behavior modification techniques. In many cases these tools can be applied by paramedical personnel. Further research is needed to gauge the effects of these techniques on risk, morbidity and mortality.