The 4 Goals of Medical Treatment and How They Affect You

Which of the 4 Goals of Medical Treatment is Right for Your Condition?

doctor and patient in hospital
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You and your doctor will want to determine one or more treatment goals -- whether you want to avoid acquiring a disease or condition, are suffering symptoms, have caught a cold or the flu, have developed diabetes or cancer, or even injured yourself in an accident or fall. All of these require treatments.

Treatments fall under four categories, based on their potential outcomes:

  • Preventive
  • Curative
  • Disease Management (including pain management)
  • Palliative

No matter which goal you choose, you'll want to consider the pros and cons of each treatment approach. What follows are descriptions for each of the treatment goals...

Preventive Treatment as a Goal: Avoiding a Health Problem Before It Starts

As the name implies, preventive treatment is intended to make sure you don't catch or acquire or otherwise suffer from symptoms, a condition or disease. Preventive care is also called prophylactic care. Some examples are:

Vaccines: We are given vaccines to prevent certain diseases that are particularly debilitating, often for a lifetime, or may cause death. Vaccines may be injected, inhaled or swallowed. Once the vaccine is given, the immune system creates antibodies to fend off any exposure to the disease later in life. Examples include: childhood vaccines for diseases like measles or polio, vaccines against diseases like tetanus or the flu that are needed at any age, and vaccines used for specific diseases someone older might acquire, such as shingles.

Genetics: With the advent of personalized medicine, and the ability to review one's genetic code, there are some instances of preventive treatments being used to fend off diseases that may result from someone's biological heritage. An example of this type of preventive care would be for a woman found to have the BRCC genes that may signify certain forms of female cancers. A women found to have the BRCC gene might choose a preventive treatment like having a breast removed to prevent development of cancer in that breast.

Preventive care may also be part of our everyday routine. We brush our teeth to prevent tooth decay. We eat certain foods or avoid certain foods to keep cholesterol levels low, or take vitamins and supplements to build strong bones, or drink orange juice to stave off colds. We wear helmets when we ride bicycles to prevent head injuries. We exercise to keep our hearts strong.

Prevention is important enough to keep us healthy that US healthcare reform, the Affordable Care Act, built in the capability for patients to receive dozens of preventive screen tests at no cost.

If prevention doesn't work, then we may need one of the other forms of treatment.

Curative Treatment as a Goal: Curing, Healing or Repairing

In the best of worlds, once we have been diagnosed with a disease or condition, we hope to return to 100% of our health. That goal requires a cure or total healing - curative treatment - and is possible for many health problems we experience. Some examples of curative treatments are:

Drugs: Some medications are intended to destroy the root of the problem, such as antibiotics that kill bacteria, anti-fungal medicines that kill fungal infections, or antihistamines which help clear up a reaction to an allergen. These drugs may be applied, swallowed or injected into our bodies.

Surgery: A surgical treatment attempts to repair a problem. For example, someone who has had his knee replaced isn't cured of knee problems, but now his new knee will make him feel cured. A child born with a cleft palate may have it repaired, but it isn't really cured, and may be passed on genetically later in life. A bad cut through one's skin may require stitches. There may be a scar, but still, the cut was repaired and the skin has healed. These approaches are all considered curative.

Broken bones can heal completely (in effect are cured) when they are treated properly, too. Sometimes the bone needs to be set back into place. Metal pins or rods may be required to strengthen those healing bones. The body part where the broken bone is located may need to be immobilized for weeks or months while it heals.

Physical therapies for muscles and other parts that have been strained or damaged, physical therapy may help heal through exercise and movement.

Time is sometimes all your cure requires while your body heals itself. It's not proactive, and requires patience, but may be all that is needed.

Curative treatments may be attempted, but sometimes they fail. Once a cure is determined to be impossible, then patients must learn to manage the problem that remains.

Disease Management as a Goal: Maximizing Longevity and Quality of Life

Many diseases and conditions cannot be cured by existing medical treatments. When a medical problem can't be cured or healed, then the goal is to manage it to make sure both the patient's longevity and quality of life are maximized by managing the problem.

Many of the diseases and conditions that must be managed are considered chronic which means they last a long time (more than three months, even through the rest of one's life) or they recur over and over again throughout one's lifetime.

Diabetes is one example of a disease that is managed. When patients manage their diabetes by controlling blood sugar and insulin levels, they can live very long lives.

Examples of other diseases or conditions which must be managed, often for the rest of a patient's lifetime, are allergies, asthma, heart disease, GERD (gastro-esophageal reflux disease), arthritis and hundreds of others. This includes diseases that may become more difficult as they progress like multiple sclerosis, lupus, Parkinson's disease or Alzheimer's Disease. Some cancers, such as melanoma and prostate, are now considered manageable for some patients, too.

Some diseases and conditions require a lifetime of management, beginning at birth or early in life. Muscular dystrophy, ADHD (attention deficit hyperactivity disorder) and autism are examples.

One important aspect of disease management is its goal of preventing another disease from developing. People with diabetes are at risk of developing heart, nerve or eye problems, for example. These additional problems are called comorbidities, meaning, they are developed in addition to, and sometimes as a result of, the original problem. Therefore one goal of disease management is preventive -- preventing the extra problem from occurring.

A Word About Pain Management

While chronic pain itself isn't usually considered to be its own condition, it often accompanies other medical problems and requires its own form of management.

This is a difficult area of medical practice because often the source of pain is so difficult to determine. Even if it can be determined, there are so many variables to the best approaches for relieving or managing the pain. From drugs to surgeries to manipulation therapies like chiropractic, acupuncture or massage, to biofeedback, even psychological approaches, pain management is unique enough to deserve its own mention.

Some forms of pain management fall under the categories of either curative or palliative care.

Palliative Care for Comfort and Relief

Palliative care is provided to patients who have severe, debilitating and life-ending disease. Its goal is to relieve symptoms such as pain, and make a patient comfortable, with little or no attempt to cure or manage the disease or condition that causes the discomfort. It is the approach to care for people who are terminally ill.

When delivered successfully, palliative care can relieve suffering for both the patient and the patient's loved ones who know the patient is benefiting from the relief.

Palliative care can also be used for patients who suffer difficult side effects from other treatment. For example, a cancer patient who suffers from nausea after a chemo treatment may be given medicine which will relieve his nausea. Such treatment is considered palliative.

Refusing Treatment and-or Choosing Death

Some patients, when they realize that none of these goals provide them with relief from their pain and suffering may choose the ultimate in patient empowerment; that is, to decide they want to be finished with life all together. They prefer to choose the right to die or death with dignity.

This is a choice patients need to be aware of for those who wish to consider it. The key is to become as informed as possible; to ask every question, to learn everything that can be learned. For obvious reasons it is not a bell that can be un-rung.

Here is some starting information about some of the pros and cons, the legality of death with dignity, how your religious beliefs might help you decide, and a variety of resources to help you become informed.

An empowered patient understands the different goals of treatment and takes them into account as she works in partnership with her doctor or a shared decision making expert to make treatment or end-of-life decisions.

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