Monday, February 2, 2009

Save Money on Health Screenings - President of American Academy of Family Physicians Wrong

The NY Times published a new section titled Patient and Money, which is particularly timely as individuals and families facing reduction in income or in some cases losing jobs are having the difficult choices between basic necessities and health care. Their piece titled "Health Care You Can't Afford Not to Afford" unfortunately was wrong. Particularly the perspective of Dr. Ted Epperly, the president of the American Academy of Family Physicians.

As a practicing board certified family doctor, I strongly disagree that screening tests can be safely skipped for months which is what Dr. Epperly was quoted as saying. The reason they are called screening tests because we do them when we feel completely fine and have no symptoms. Research has consistently shown that these do save lives. Whether the American Cancer Society gave him some criticism for his comments (he acknowledges that “The American Cancer Society wouldn’t like me saying so,” Dr. Epperly said, “but you can stretch out those tests when you need to.”).

Yet, in the same article he highly recommends that people get an "annual physical" done which research also consistently shows isn't worthwhile! From the article "If you’re due for your annual physical, for instance, and you feel fine, you can wait a few months before forking over that hefty co-payment. Even children, once they are past vaccination age, can skip a check-up or two, as long as they are healthy and at a normal weight." Indeed, having an annual physical done randomly is no better than taking your car for a check-up when it is running perfectly well. What do you think your mechanic will say? Everything is fine. Randomly dropping by your auto dealer is different than taking your car in for a scheduled maintenance.

Knowing when you must get checked is far better than just dropping in on an annual physical. If Dr. Epperly means an annual physical is the only way you can figure out if you are obese, need to be screened for high blood pressure, or diabetes, then that's different. (Those on prescription medication for conditions like high blood pressure, high cholesterol, heart disease, diabetes should be checked annually). But for the most part, most of us who are healthy and aren't on medications can figure that out ourselves. The trouble is in our busy lives how do we remember to take a time out and assess our health? Do it at New Years or every year on your birthday.

When should you go in and what tests should you ask for (if your doctor forgets to remind you or is squemish about screening for colon cancer - only those readers 50 years and older, possibly younger in people with family history of colon cancer) can be found in Do the Right Thing Regularly and Repeatedly - Preventive Screening Tests and Interventions for Adults. Helpful websites to keep you healthy and well in addition to figuring out when to see your doctor are right here.

For decreasing drug costs, I would add that Walmart and Target's $4 /$10 medication option is a great one as many high quality medications are available. I would also add that Consumer Reports has a free website called CRBESTBUYDRUGS.ORG which lists the best medications for
the money.

For your symptoms, understanding when to see the doctor and when you don't need to is as simple as going to the American Academy of Family Physicians website - and clicking on the symptoms check link - Search by Symptoms.

Also realize that giving doctors a good medical history about your symptoms prevents us from ordering too many tests / imaging studies which cost money and time. Unfortunately, if you simply tell us that your back hurts and are unable to say what makes it better or worse, what the pain feels like, how long it lasts, if you've had other symptoms with it, among other important information, doctors meaning to help will prescribe medications and do tests which may not help you get better, but hurt your wallet more. This is particularly challenging as doctor visits are getting shorter and doctors, research shows, cut patients off in 23 seconds.

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