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Deb Beaulieu |
Like a lot of busy, relatively healthy adults, I don't think twice about bringing my kids in for their annual checkups, but I tend to see my own as a lower priority. But because I go to a practice that schedules my next appointment before I walk out the door--rather than leaving me to keep demoting that phone call to the bottom of my to-do list--I have dutifully gone for my annual checkup the past several years in a row.
Showing up for this appointment doesn't make me any less likely, statistically, to die from cancer or heart disease. Considering that my health plan foots the bill for only part of my annual lab work, this is discouraging. Nonetheless, I did learn this year that my cholesterol had started to creep up--a helpful reminder that a "marathoner" should be careful to eat like one during periods of actual training. In my mind, this reality check nearly epitomizes the purpose of the annual checkup: To catch emerging problems before they become big ones.
Sure, over the course of all the years I've been going to doctors for routine care, I've received a handful of false positives for various tests and issues. Most of them represented a minor nuisance, while a couple were indeed rather stressful. Looking back, it was the way the physicians handled these unexpected issues that truly defined the doctor-patient relationship. I have dumped doctors who treated me like a file rather than a person. Those with whom I've formed a trusting bond, through good times and bad, I'll stick with as long as possible.
As a patient and advocate for physicians, by way of my job, I see the pros of the annual adult checkup far outweighing the cons. Still, the list of issues primary care doctors are urged to cover with patients keeps getting longer. Although not everyone agrees as to whether all these conversations are appropriate or feasible, there's pressure on doctors to ask about possible domestic violence, screen for alcohol abuse and safe gun ownership--and those are just issues that have emerged in the past several months.
So it's not all that surprising Physicians Practice blogger Melissa Young, an endocrinologist in private practice in New Jersey, recently quipped, "What's next? Are we going to be required to ask patients if they've cleaned the lint trap in their dryers?"
I do hope it never goes that far. Ideally, I'd like to see doctors use their intuition and discretion in determining what questions to ask. Most of the practices I've visited use some type of standard list, which a nurse or medical assistant typically runs down before the doctor shows up. Sometimes, doctors add in questions of their own. Over the course of a lifetime, a patient like me will answer "no" to most of the questions most of the time.
But there's always the chance of a "yes." Especially when it comes to sensitive issues, I'm probably not the only one reluctant to raise certain subjects unless asked directly. Even if a patient still answers "no," perhaps out of embarrassment or sheer habit, a provider might note that his or her body language seems different this time or pick up on other subtle clues to question further.
According to a recent report from the Mayo Clinic, the top reasons patients visit doctors are skin disorders, followed by joint, back and cholesterol problems. Anxiety and depression represent the sixth-most-common reason for visits, trailing just behind upper-respiratory conditions. The research did not indicate whether patients initiated these visits or how severe the problems were when they were addressed.
But much like my cholesterol creep, touching base on whatever list of problems for which you deem your patients are at risk might identify emerging issues before they become debilitating. If research shows an annual Pap test or other lab work isn't really necessary, so be it. There are plenty of other valuable ways to spend that 10 or so minutes once a year.
Think patients won't bother to make an appointment that involves more chit-chat than tests? Don't bother trying to sell it. When they come in on their own volition to get their acne cleared up, attempt to book them for a preventive visit before they walk out the door. When they arrive, make sure they know you're listening. - Deb (@PracticeMgt)