Occasional Reviezv Strategy of prevention : lessons from cardiovascular disease GEOFFREY

If an obstetrician had a case of eclampsia he would ask, "What went wrong ?" The occurrence of a preventable disaster is a threat to his professional reputation, for an obstetrician accepts prevention as an integral part of his normal professional responsibilities. Antenatal care is in fact largely preventive, and the integration of prevention with treatment has led to an excellent fall in maternal and perinatal mortality rates. In paediatrics too there are no demarcation disputes between prevention and treatment; and a similar trend is now also appearing in general practice. If a stroke occurs in an untreated or badly treated hypertensive patient, a good general practitioner asks, "What went wrong ?" For, in middle age at least, strokes are largely preventable. When one occurs it suggests a possible failure of practice organisation.