Preventive screenings: How to improve your health with help from your doctor
For Angie’s List member John Granger, peace of mind means being proactive about his health.
Twice a year, his dermatologist screens him for skin cancer because he has a family history of it. Once a year, his family doctor at highly rated La Jolla Family & Sports Medicine in San Diego checks his blood pressure, cholesterol and prostate.
“In my 20s, I had a sense of invulnerabilty,” says Granger, now 60. “As you get older, if you have your health, you realize how lucky you are and you want to safeguard it.”
Members, doctors and experts agree preventive screenings are key to identifying and treating potential health issues before they get worse.
More than 40 percent of Angie’s List members who answered a recent online poll say the tests helped them catch problems early, listing blood pressure and cholesterol as the screenings they’ve received most often, followed by Pap smears and colonoscopies. But 30 percent of respondents reveal they know of a test they need but haven’t taken.
Screenings can save lives and money, says Dr. Steve Smith, a family medicine specialist at highly rated Community Health Center of New London, Conn. However, deciding on the right tests — including those for prostate cancer, diabetes and skin cancer — can be daunting because medical groups across the country disagree on what screenings are needed and the age testing should begin.
What’s a patient to do? Consult with your doctor, says Smith, who’s also the director of Promoting Good Stewardship in Medicine, a project that is identifying steps doctors can take to improve quality and reduce costs. Your physician can help you decide the right screenings for you based on personal and family medical history.
However, Smith says patients who have no symptoms and are otherwise healthy tend to have the mindset that more testing is better.“Prevention for a lot of people is like motherhood and apple pie,” he says. “Who can be against it? But it can be misused and carries risks.” He suggests doing your own research and discussing the benefits and risks with your provider to avoid overtesting.
Patients also need to keep up with changing screening recommendations. In March, groups such as 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 risks of each test. The task force says mammograms pose the most benefit with the least risk at age 50, and that insufficient evidence also exists to justify a prostate-specific antigen, or PSA, test to detect cancer in men. For both, it says the risks include unnecessary biopsies and surgeries.
This has caused controversy, particularly in the past few years, among organizations like the American Cancer Society. The ACS says women should start mammograms at age 40 and suggests that men ages 50 and older discuss PSA screenings with doctors.
Dr. Robert Smith, senior director for cancer control with the ACS, acknowledges the risks, but says its goal is to save lives by catching problems early. “We think the benefits outrank the harms and they say the harms outrank the benefits,” he says. Regardless, he adds, patients must be proactive with their health care.
Member Mary McFadden Busch of Lexington, Ky., says breast cancer killed her half-sister at age 38, and at age 41, she was diagnosed with breast cancer. She says she complained every year to highly rated Dr. William Wittman of Lexington Clinic, about getting screened. “To paraphrase with my Southern charm, he said, ‘Suck it up, buttercup, and go do it.’ I’m glad he did. When my cancer was caught, it was not quite Stage 1. She says she’ll make sure her 23-year-old daughter gets early mammograms: “If I have to pay for it out of pocket, she’s going to start.”
Under the 2010 Affordable Care Act, most health insurance policies cover preventive services. Before any screening, experts suggest checking with insurance to make sure.
Keith Eickhoff, 73, of Hilton Head Island, S.C., follows most of his doctor’s recommendations, such as annual cholesterol checks. And when a PSA and subsequent biopsy found cancer five years ago, he treated it successfully. But Eickhoff won’t get a colonoscopy, a screening for colon cancer recommended for adults starting at age 50.
“I know several people who’ve had near-death experiences because of infections due to perforations,” he says. The rate of serious complications is about 25 per 10,000 procedures, according to the USPSTF. Eickhoff is unswayed by the numbers. “There’s always a chance you could cause a problem when you don’t have a problem,” he says. Instead, he receives the less invasive fecal occult blood test.
Dr. Vincent Bufalino, a cardiologist with highly rated Midwest Heart Specialists in Elmhurst, Ill., sees more good than harm in screening tests, particularly in battling the No. 1 and No. 4 killers of Americans: heart disease and stroke. He welcomes the growing number of retail health clinics who are playing an increased role in preventive care by offering screenings, such as low-cost blood pressure, cholesterol and diabetes tests. The clinics add convenient access to health care for consumers who might not have time to schedule a visit with their doctor.
“We’d love to get folks screened any way they can get screened,” Bufalino says. But he also cautions test results need the input of a primary care doctor, adding symptoms caught early can be handled by that doctor and not need a specialist’s intervention.
WellPoint, one of the nation’s largest health insurance providers, is changing the way it reimburses primary care doctors, switching from fee for service to rewarding physicians for keeping patients healthy. That means written health plans for people with chronic diseases like diabetes, and ensuring patients are up to date on immunizations and preventive screenings.
“Preventive efforts coupled with a strong doctor-patient relationship pay off in terms of improved health and lower costs,” says Brandon Davis, WellPoint corporate communications director. The most significant savings will come through reduced ER visits and hospital admissions, he adds.
Dr. Ari Levy, associate medical director of the Program for Personalized Health & Prevention at highly rated University of Chicago Medicine, says they’re pursuing a similar goal. “I practice for one reason: I really love healthy people,” he says. “We can help people live healthier, but [the U.S.] health system is not set up to promote that.” Obesity and chronic diseases continue to rise, he says. He attributes this in part to medicine’s focus on putting out fires rather than trying to prevent them.
At the heart of the University of Chicago program is a daylong physical involving dietitians, cardiologists, internists and other specialists under one roof. The exam costs about $3,200, a benefit covered by few health plans, but Levy says the total would be $10,000 if a patient saw each specialist separately. The result is a comprehensive health profile. Ultimately, preventive medicine requires lifestyle changes, Levy says. He can’t force patients to change, but the more time he spends with them, the more influence he’ll have.
Angie’s List member Frank Feraco, 64, of Barrington, Ill., says Levy changed his outlook. Feraco’s health profile covered everything from blood pressure to dry skin. It also included an exercise and diet regimen. Feraco began swimming, ate more fish and less red meat, dropped 15 pounds and now says he has the blood pressure of someone half his age. Feraco says, “I told Dr. Levy, ‘Keep me going for 30 years.’ He said, ‘I can get you 10 and the rest is up to you.’"