Preventative Care: Part 1, Approach
/“It is more important to prevent the occurrence of disease than to seek a cure.”
Sometimes it seems there are two kinds of people out there that manifest as patients. The first one is the hypervigilant type, let’s call these people Type 1. They constantly read about health issues, supplements and vitamins, they research medications, come in for regular check-ups and are very reassured by having all their scheduled preventative screenings done in a timely fashion. You guys are my box checkers, my people with carefully put together folders, neat lists of questions complied over the intervening months, waiting for that 30 minute visit to present your inquiries and demonstrate your diligence. I love you guys, you are a joy to work with.
The other type, Type 2 by default, are those that wait until something is grossly wrong. A bunch of you latter types are lucky enough to be married, often you are men (but definitely not always), and your worried spouse knowing you all too well will nag you until you drag yourself into an exam room before whatever is in question actually falls off. To you my friend, know that I love you dearly as well. Here’s why. While I look forward to the day when no one ever balks when I tell them it’s time for a screening colonoscopy, I appreciate people who are highly practical, even if it is to a fault. People who identify as self-sufficient, DIYers, and noncomplainers are usually who comprise this category. And while I am in no way giving anyone permission to ignore health problems or never see a doctor, some of you more practical Type 2s may be onto something.
Perhaps Reader, you have identified with one of my types, perhaps not. Of course, there are outliers, often somewhere in between. Such is where truth often lies. Either way, what has this to do with the title of this post? The impetus for this written rumination was actually from a piece on “Health Checkups” from Choosing Wisely. For those who have never heard of Choosing Wisely, this is an online organization started in 2012 via the American Board of Internal Medicine and Consumer Reports dedicated to educating health care providers and patients about the do’s, do not’s and why’s of medicine (link below). I was in search of their write up for colonoscopy for colorectal cancer screening and stumbled over “Health Checkups”. I clicked the link, assured I would find a few paragraphs (all their patient material is a page or less) on why its important to see a primary care doctor regularly. I was surprised, and somewhat pleasantly so, to find that it actually does not. The article does state the importance of having a “regular doctor” and heading the advice given in that relationship. But the article very rightly points out that getting that annual physical exam doesn’t make you healthier. WHAT? They don’t, and honestly folks, your doctor knows it. Unless you have chronic health issues, which many, many people now do (AKA if you take medication regularly), have recently had major surgery, a significant accident, had a baby or abuse yourself in some way (like drinking alcohol daily or do drugs, engage in high risk sexual activity to name a few), you do not need blood work every year. Nor do you need to have someone auscultate your heart and lungs annually. For those of you who have attended an annual doctor’s visit how many of you have walked away kind of feeling as though, maybe, that was a waste of time? I know, I know, the reassurance is precious. It feels so good to have someone sit, listen, and look at you. Before I vilify myself too much, know that I regularly see patients. Again most of those are people with chronic health issues. But, I also see plenty of people annually that I wouldn’t otherwise simply because they want to be seen. My Type 1s, they love checking those boxes.
I am not complaining, nor even inwardly rolling my eyes. But here is the potential problem: when you go looking for, well anything, you will eventually find something. A funny noise, a strange spot, a fuzzy radiodensity, in other words: a blip in the data that may send you down a rabbit hole. We call these incidental findings. And while people have been incidentally found to have some major issues, that number is very small. Mostly, a blurry nodule, a slight shift in a lab value or a vague complaint that could be initially addressed with simple lifestyle choice changes will create a storm of further labs tests , imaging, unnecessary procedures and specialty referrals that not only exponentially increase the cost of health care but potentially generate harm to you, the patient. We wave these two big administrative banners of Western Medicine on media platforms daily, basically “Do No Harm!” and “Decrease Healthcare Costs!”. And we look to our doctors, our medical institutions and our governments to make these things happen. Here’s the thing though, Reader. The change starts with you and me. Very rarely will you find a piece on this site extolling the virtues of health care policies. While healthcare delivery systems certainly need some fundamental change, on a global scale indeed, the place it starts is the individual. From my perspective there is not enough conversation around this. The way we start on that individual level is through education. How your body works, how to help it work the best, what are signs of problems, what are the times when it is necessary to see a doctor, how medicine helps and how it can actually hurt. Additionally, it has become tantamount for consumers of health care (“patient” is becoming an inappropriate term these days) to understand how the system works. Why doctors want you to do certain things. Who should take an aspirin daily? Why does your doctor want you to have a colonoscopy? Why, on God’s green earth, does the damn doctor take so long to get to you?? Oh, those wait times…. Why it all costs so much. There are reasons, Reader, sometimes good, sometimes…. eh, not so much. I tell my patients, all the time, that my primary job is as an educator. I love teaching people the little bit that I know (I love medical students!). You, as a patient/consumer, cannot make a decision on any given medical issue without full understanding of the risks, benefits and alternatives tied to the choice. That is my job, in a nutshell, to help you understand. I certainly do love biopsies and test interpretations, diagnosing complex issues… its why I signed up in the first place. But it’s the educator part that is the most critical area of my job, and that is the part I wish to share with you here. I’ve labeled this post as Part 1. I am not sure how many Parts I’ll pull out of this. But I know Part 2 will look at the details of overall intention of this introductory piece: when to see a doctor and why. Stay tuned, all of you.