Indianapolis health experts, patients discuss the benefits of preventive health screenings
Preventive care gives Linda Frechette peace of mind.
With a family history of breast cancer, the 56-year-old underwent her first mammogram 21 years ago, which led to the removal of a benign tumor. In November 2010 during an annual checkup, Dr. Joseph Beardsley, a highly rated gynecologist at Beech Grove Ob-Gyn, uncovered issues with her thyroid and gallbladder.
Today, the Angie’s List member continues to receive preventive care. “It’s important just to stay on top of your own health because then there are no surprises,” Frechette says.
Identifying potential problems
Members and doctors agree preventive care, including screening tests, is key to identifying potential problems. More than 40 percent of Angie’s List members who answered a recent online poll say preventive tests uncovered previously unknown health issues.
Blood pressure and cholesterol checks are the most popular, according to poll respondents, followed by Pap smears and colonoscopies. Yet 30 percent who took the same poll say they avoided ones they knew they should’ve had.
Deciding on the right screenings, including those for prostate cancer, diabetes and skin cancer, can be daunting, especially because medical groups across the country disagree on whether some of them are needed and the age testing should begin.
Experts say the best defense is to team up with a primary care doctor and decide when to tackle screenings based on your age and personal and family medical history. They also suggest doing your own research and discussing the benefits and risks with your provider to avoid overtesting.
Dr. Gary Larkin, state health commissioner, agrees people need to talk with their doctor because heart disease, cancer, chronic lower respiratory diseases and stroke make up the top Hoosier killers.
“Preventive practices such as cancer screenings, early treatment, vaccinations, addressing nutrition and physical activity, and stopping tobacco use have been demonstrated to reduce the burden of disease,” Larkin says. But he admits getting people to see a physician or undergo tests can be a challenge.
Early detection saves lives
For years, Angie’s List member Stuart Meyer of Greenwood, Ind., avoided doctors, anxious about what they might find. Then doctors discovered his wife had a large benign tumor that could’ve been caught earlier, if she hadn’t skipped an annual exam. Meyer, 47, says he changed his tune and developed a relationship with highly rated Dr. Ronald Bennett from highly rated rated American Health Network in Franklin, Ind. They discussed his family history and Bennett ordered a colonoscopy.
"My dad had precancerous polyps in his late 50s, and I have an uncle who died at 52 of colon cancer,” says Meyer, who adds the screening found two precancerous polyps that were removed. “If you know anybody that’s skipped going to the doctor and had problems, it really brings it home,” he says.
At highly rated Priority Physicians on the Northside, four doctors practice family and internal medicine under one roof where they focus on preventive care and building relationships. Patients, including member Dave Comer, undergo an extensive three- to four- hour annual exam that includes a lengthy doctor consultation, physical and screenings, such as dermatologic scans, a treadmill stress test, and heart and lung scans.
The doctor’s goal is to catch and treat disease earlier, says Comer’s physician, highly rated internist Dr. Shelagh Fraser. Tests often unveil high blood pressure, high cholesterol, or in Comer’s case, calcium buildup in his arteries, she says. “In the flurry of everyday activity, these things that are asymptomatic, they get lost,” Fraser says.
The practice doesn’t bill insurance and charges patients an annual fee based on age. Comer and his wife each pay $5,500, which they say is money well spent. “Shelagh actually knows who I am,” Comer says. “She spends a lot of time going over what your body’s been doing.”
Staying pro-active as a patient
Patients also need to stay on top of what tests they should receive, and should know that recommendations can change. In March, groups including the American Cancer Society, announced women should receive a Pap smear to screen for cervical cancer no more than every three years.
This differs from earlier guidelines that recommended an annual test. Likewise, a few years ago the U.S. Preventive Services Task Force — an independent panel of primary care providers appointed by the federal government — raised the recommended age to start mammography screening from age 40 to 50.
The USPSTF bases its recommendations on scientific evidence, looking at the benefits and harms of each. It says mammograms pose the most benefit with the least risk at age 50, and says there’s insufficient evidence to justify a prostate-specific antigen (PSA) test to detect cancer in men. Both tests, it says, can lead to unnecessary biopsies and surgeries.
This has caused controversy among medical groups such as the American Cancer Society. They say women should start mammograms at age 40 and suggest that men ages 50 and older discuss PSA screenings with doctors. Dr. Robert Smith, senior director for cancer control with the ACS, doesn’t deny there are risks to screenings, but says their goal is to save lives by catching problems earlier.
“We think the benefits outrank the harms and they say the harms outrank the benefits,” he says. Regardless, patients must be proactive in their health care.
The medical community agrees preventive care is the best and least expensive way to treat patients because it could reduce emergency room visits, acute care hospital admissions and chronic diseases. One insurance company is working to shift the focus toward prevention. In January, Indianapolis-based WellPoint announced a new pay-for-performance program where doctors and hospitals can earn more money when they maintain or improve patient outcomes.
“Prevention efforts coupled with strong doctor-patient relationships pay off in terms of improved health and lower costs,” says Brandon Davis, WellPoint corporate communications director. “We know [providers] can improve coordination, prevention and wellness. It’s the foundation of medicine.”
A range of screening options
Under the 2010 Affordable Care Act, most health insurance policies cover preventive services. Before any screening, experts suggest checking with insurance to make sure it’s covered.
Some patients turn to in-store retail health clinics that play an increased role in preventive care and offer low-cost cholesterol, diabetes and blood pressure tests for those who might not have time to schedule a visit with their doctor.
Larkin, the state health commissioner, says any check is better than none at all, but patients need to advocate for themselves to ensure their doctors receive information about visits outside their offices.
Tests at a walk-in clinic or specialist’s office could unveil signs of a larger problem or medications might need to be adjusted. “Most things are pretty routine, but there are times when sharing the right thing at the right time is critical,” says Dr. Stephen Jay, founding chair of the Department of Public Health at IU School of Medicine.
For 20 years, member Kimberly Schoff of McCordsville, Ind., has seen highly rated internist Dr. Patricia Wesley in Carmel and undergoes regular preventive care such as a mammogram, biannual bone density screening and blood pressure check. Heart disease runs in her family, so she’s also undergone a baseline electrocardiogram, or EKG. “Preventive maintenance is a good thing,” says Schoff, who just wants to live a healthy life.
Wesley emphasizes the importance of being proactive with your health. “Mammograms can find a cancer that can be treated and cured,” she says. “Cholesterol checks could prevent heart problems. There are too many conditions that can develop as you age that you can be unaware of.”