Why is it so important?
Most people think of getting medical care when they’re sick or injured. However, this isn’t the only time you should be going to the doctor. Adults, just like kids, should have well visits. These appointments are vital to keeping you healthy both in the short-term and long-term. By being healthy, you’ll have fewer medical problems throughout your life. How often should you see the doctor? Are there specific things that should be done at certain ages?
How often do you take your health for granted? How often do you neglect to take the steps which could help you prevent disease? If you’re like most people, this is something you do every day, but you shouldn’t. Preventable causes of death lead to an estimated 900,000 deaths per year. According to the Center for Disease Control and Prevention (CDC), 70% of deaths in the United States result from chronic disease and 50% of the population has some kind of chronic illness that has been classified by the medical community as preventable. Chronic diseases are conditions like heart disease, cancer, chronic lung disease, stroke, Alzheimer’s, diabetes, osteoarthritis, and chronic kidney disease. Besides increasing the chances of early death, chronic diseases greatly reduce the quality of life for patients and their families.
According to the American Heart Association (AHA), about 92 million US adults have cardiovascular disease or have suffered a stroke. The organization similarly points out that approximately 60 million Americans have high cholesterol levels, which is a significant risk factor for heart disease. Smoking also increases the risk of dying from preventable diseases. For instance, those who smoke have heart attacks twice as often as those who don’t. Another factor is obesity, which can precipitate other diseases. Since over two-thirds of adults are obese, this is concerning. Over the past several decades, the prevalence of diabetes has increased dramatically. In 2015, more than 29 million Americans had diabetes and another 86 million had prediabetes. Per CDC estimations, 7.2 million people in the US have undiagnosed diabetes. Diabetes raises the risk of developing other chronic diseases.
In addition to health issues, chronic diseases place an enormous financial burden on both patients and the healthcare system. They’re the leading source of healthcare costs in the country. In 2016, total direct costs for treating chronic diseases were over $1 trillion, with diabetes, Alzheimer’s, and osteoarthritis being the most expensive. Working often is difficult for people with chronic diseases. So, they have higher rates of absenteeism and lower-income than people who don’t have one. Thus, if you factor in lost economic productivity, the total cost rises to $3.7 trillion, which is close to one-fifth of the entire US economy. Regrettably, these costs are expected to increase as the population ages. Current projections indicate that by 2030, more than 80 million people nationwide will have at least 3 chronic diseases. Demographic, environmental, economic, and social factors put rural residents at higher risk from the five leading causes of death, which are heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.
An article published by Saint Louis University states that maintaining good health typically results in lower healthcare costs. Different research from the Journal of Health Affairs shows that regular visits with a doctor help reduce overall health costs. This is because conditions, especially chronic ones, are easier to treat when detected at an early stage. Prevention discourages the incidence of a disease, or stops, slows, or reverses the progress of an acute condition. Healthy People, a federal program administered by the United States Department of Health and Human Services (HHS), back this concept. According to their data, routine cardiovascular exams save tens of thousands of lives each year, and vaccines save about 42,000 children annually. Several studies have found that preventive health screenings and primary care consultations significantly increase life expectancy, particularly among those between 30 – 49 years old.
Preventative medicine isn’t just for currently healthy people; it’s also about managing chronic illnesses to lessen pain, reduce symptoms, and avoid complications. This is why there are three stages. Primary is intervening before disease occurs, secondary is detecting and treating disease at an early stage, and tertiary is managing disease to slow or stop its progression. Primary preventive medical care includes annual physicals and other doctor visits, well-woman appointments, contraception, regular dental care, immunizations, and allergy medicine. According to the U.S. Department of Health and Human Services (HHS), preventive medical care also includes tests to check for diabetes, blood pressure and cholesterol, screenings for cancer (ex. colonoscopies and mammograms), counseling to help patients lose weight/quit smoking/eat healthy foods, treat depression, manage alcohol use, well-baby checks, regular pediatric wellness visits through age 21, prenatal wellness checks, and seasonal shots for flu and pneumonia.
Despite the benefit preventative care offers, there seems to be a continued reluctance among some to take advantage of the currently available measures. Currently, four out of five Americans have healthcare coverage, but 25% didn’t receive routine checkups. The U.S. Census Bureau states that women are more likely than men to visit their doctor regularly. Roughly 22% of adult females and 33% of adult males didn’t visit a medical provider in 2010. Since men tend not to visit their doctor as often as women, this can possibly explain why they live an average of seven years less. Underutilization of preventive services is thought to result from an implementation gap rather than an information gap. Part of this could be the result of providers not prioritizing primary preventive care services even though they know that it can reduce the incidence and burden of chronic diseases. The reason for this is that most providers are paid to treat conditions rather than to prevent them. These statistics signal a need for greater national emphasis on preventive approaches to healthcare.
Increasing the utilization of preventive services is going to require a multifaceted strategy. Some financial and economic considerations will be where to invest resources, what health benefits to cover, and how to bill for services. Another aspect is using the “right” metrics to encourage healthcare provider participation. The metrics should be outcome-focused, aligned across payers, and with sufficient financial incentives or risk. A further consideration is basing payments to providers based on improvements in their patients’ health status. The shift from volume-based reimbursement to value-based reimbursement could be very effective, but it’s still in the early stages and is unevenly applied across payers. Insurance companies are the ones who pay the majority of the bill for medical care, so they’re motivated to promote care that leads to fewer claims. This is why most health insurances now cover preventive care programs, which means you don’t have to worry about copay or deductibles if you see an in-network doctor.
Public health officials and some politicians recognize the importance of preventative healthcare, which is why the Affordable Care Act (ACA) policies require providers on the Marketplace to cover preventive measures for adults and kids without a copay even if you haven’t met your plan deductible. For adults, a partial listing of what’s covered is abdominal aortic aneurysm screening for males who ever smoked, alcohol misuse counseling (includes screening), aspirin use for cardiovascular conditions and colorectal cancer for high-risk adults, screening for blood pressure, cholesterol screening for high-risk adults, colorectal cancer screening (ages 50 to 75), screening for depression, screening for diabetes (Type 2) for obese adults ages 40 to 70 years, diet counseling for high-risk adults, and falls prevention for seniors age 65 years and over. For children, a partial listing includes adolescent assessment for drug and alcohol use disorders, autism screening for toddlers aged 18 to 24 months, behavioral assessments at varying stages (such as 11 months, 4 years, 10 years, 14 years, and 17 years), bilirubin concentration screening for newborns, blood pressure screening at various developmental stages, newborn blood screening, screening for cervical dysplasia for sexually active girls, depression screening typically beginning at age 12, and developmental screening for preschool kids under 3. ACA isn’t the only program supporting preventative healthcare; the American College of Preventive Medicine (ACPM) is a society of 2,000 doctors committed to improving the health of families, individuals, and communities by avoiding disease and promoting health initiatives. They work in cooperation with the CDC. Their initiations focus on improving overall health conditions with programs that pay attention to brain health, diabetes prevention, reducing hypertension, lifestyle medicine, population health, and violence prevention.
Preventive care is the most important thing you can do to manage your health and the best part is you’re in control of it. Obviously, it’s easier to make decisions when you have accurate information and your healthcare provider’s guidance. The first part of the process involves a thorough physical examination, during which your doctor will ask detailed questions about your medical history and that of your close family members. Depending on your overall health, gender, and age, your doctor will recommend specific preventive care actions. If you have a chronic condition, your doctor can recommend steps that might reduce symptoms and improve your quality of life. Any changes recommended by your doctor should be manageable and will often include lifestyle choices, like diet, exercise, and smoking, not just screening services. Since stress can be harmful to your health, your doctor will also want to address that and suggest ways to minimize it in your life. It’s key to find a healthcare practitioner that you feel comfortable with and trust. You should be able to have a real conversation, ask questions, discuss concerns, and address any fears. Be an advocate for yourself and those you love. Part of maintaining your own health through preventative medicine is to model the behavior you want the children in your life to display. At every stage through life, there are screenings for both men and women. The following preventive medical care guidelines are approved by the National Institute of Health (NIH).
Newborns must have routine examinations several times within the first two years of their lives. After that, the standard is annual or bi-annual well-child visits. The purpose of these appointments is to help protect children against a wide range of diseases/infections and monitor/evaluate their bodies as they grow and develop. Sadly, according to HHS, over 10% of young children don’t receive the recommended preventive medical care. For newborns, the check-up schedule is pre-birth, newborn (two to three days after the baby is released from the hospital), 1 month, 2 months, 4 months and 6 months, and 9 months (CDC recommends screenings for Autism Spectrum Disorder (ASD) and other developmental delays at this visit). In addition to their well-child visit with a pediatrician around their first birthday, the American Academy of Pediatric Dentistry advises that parents schedule their child’s first dental visit around this time with subsequent dental check-ups taking place every six months. Most one-year-olds are also ready to consume fruits and vegetables, meats, and grains (provided these foods have been chopped or otherwise prepared for infantile consumption). Children can transition from breast milk/formula to whole milk at some point between one to two years of age. It’s important to note that low-fat milk is not recommended for children under the age of two. From the ages of 30 months to 10 years, parents should schedule well-child visits at 2 ½ years, 3 years, 4 years, 5 years, 6 years, 8 years, and 10 years.
Adolescents also experience a period of rapid growth, both physically and emotionally/intellectually. During this time, clinicians should counsel teens about lifestyle choices, like sexuality, pregnancy, substance abuse, and peer pressure. It’s estimated that there are 19 million STI (sexually transmitted infections) cases every year involving patients between the ages of 15 and 24. The National Institute of Drug Abuse did a survey in 2013 that found that 3.5% of 8th graders, 12.8% of 10th graders, and 26% of 12th graders reported consuming alcohol to the point of drunkenness at least once in the prior month. The survey also discovered that 9.6% of teens declared they were addicted to cigarettes. Per data from StopBullying.gov, 1 in 3 students indicate they have been bullied at their school. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) asserts that anorexia is the third most common chronic mental illness in the country and close to 95% of those with it or bulimia are between the ages of 12 and 25. According to Mental Health America, more than 2 million people across the country (primarily teenagers) say they’ve tried to harm themselves. By teens visiting the doctor regularly, they can address these topics and look for any warning signs that might be present. Adolescents should go for a well visit at least once every year between the ages of 11 and 19. They should also continue to see the dentist every six months.
Once you reach adulthood, the well visits shouldn’t stop. There are certain health issues that should address lifelong. An important one is blood pressure. Even if it’s within normal limits, you should have it evaluated every two years. If it’s slightly above average, you should be screened annually. If it’s extremely elevated, your doctor will provide guidance on the frequency of checks. Adults should also be screened for diabetes and cholesterol between the ages of 20 and 45. After the initial exam, the testing frequency will depend on your weight, physical shape, and diet. Since skin cancer affects adults of all ages, you should be screened yearly. You should also go to the dentist at least once a year. Even if you have perfect vision, you should still get a vision test every few years. Adults need to stay up to date on vaccinations, such as the annual flu shot and TDAP.
Some examinations are gender-based. Women should visit a doctor every two years between the ages of 20 and 39. Beginning at age 20, women should have a full breast exam from their physician every three years and perform a ‘self-exam’ of each breast monthly. Pelvic exams and Pap smears help detect cervical cancer, certain STIs, and other health problems related to the female reproductive system. Women should have their first pelvic exam from an OB-GYN within three years of their first experience with vaginal intercourse or by the age of 21. Following the initial screening, a full pelvic screening and Pap smear need to be completed every two years. Women over the age of 30 or those who receive three negative tests in a row might be able to extend that to every three to five years. During these visits, it’s a good idea to discuss birth control methods and which will work best for you. Sexually active females ought to be tested for STIs at least once per year. Since the HPV vaccine can prevent cervical cancer, women who haven’t received it are encouraged to do so before turning 27. For men between the ages of 18 and 39, they should see a doctor every two years. About 50% of men diagnosed with testicular cancer are between the ages of 20 and 34. This is why men are encouraged to perform a self-exam after bathing (when the scrotum is relaxed). Men are also encouraged to acquire the HPV immunization before the age of 26 because this will prevent them from passing the virus to women. Men should also be screened for other STIs every one to three years.
Although women aged 40 to 64 are less likely to give birth, they still must contend with medical issues related to their reproductive system. Women who are not considered high-risk for breast cancer and are over the age of 50 may schedule mammograms every two years. On average, 33% of women will have a hysterectomy by the time they turn 60. A partial hysterectomy is removing a woman’s uterus and ovaries; whereas, full and radical hysterectomies also remove the cervix. Women who receive a full or radical hysterectomy may not need Pap smears any longer and those who have a partial hysterectomy may reduce the frequency of Pap smears to every five years. Osteoporosis is more common in women. Per MedLine, half of the women over 50 will suffer a fractured hip, wrist, spine, or other bone injury due to osteoporosis during their lifetime. This is why women 50 and older are urged to have a bone mineral density test. Men who are at high risk for osteoporosis should also get one. Most men can wait until the age of 50 to start getting prostate cancer screenings. Colorectal screening for both men and women should start at 50 and include a stool guaiac test every year, sigmoidoscopy every five years, barium enema every five years, “virtual colonoscopy” every five years, and colonoscopy every 10 years. Individuals with certain risk factors may need to receive a colorectal screening more frequently. After the age of 60, men and women should get the shingles vaccine in addition to the yearly flu shot.
At 65, women who aren’t high-risk for osteoporosis should receive a bone mineral density test. After 65, if you’ve had three negative Pap smears within the last ten years, you can stop getting pelvic examinations and Pap smears. Between 65 and 74, women should continue to receive mammograms every two years. At 75, women can discuss with their doctor whether you’ll need to continue with them. All men over 65 are more vulnerable to an abdominal aortic aneurysm, so they should be screened. Men and women should continue to receive regular colorectal exams until the age of 75. Both genders are at increased risk of developing glaucoma after the age of 65. So, regular check-ups with an optometrist are encouraged. Men and women over 65 should receive pneumococcal (pneumonia) and flu immunizations yearly.
The COVID-19 pandemic emphasizes the importance of preventative care even more than before, but these visits have declined significantly since the pandemic started. According to the nonprofit Health Care Cost Institute (HCCI), wellness exams decreased by around 80%, colonoscopies/mammograms were down about 90%, and childhood vaccinations decreased around 60% in April when compared to the same time period in 2019. By June, colonoscopies were still down 30%, mammograms stayed down 23%, and vaccinations for children remained down 30%. Many health experts are concerned. Doctors are worried about those not getting cancer screenings because cancers are more complicated to treat if caught at a later stage. In addition, quarantining has negatively affected many people’s mental health, especially the senior population because they’re not as familiar or comfortable with the virtual interaction and technology that we’ve come to rely on during social distancing. The physical distancing and isolation have led to feelings of loneliness, grief, anxiety, and stress increasing significantly among all populations. All of these can have long-standing psychological effects. One thing that experts stress the importance of is immunizations, especially during the pandemic. Regular and timely vaccinations safeguard us against diseases. It’s vital for kids that they get all of the necessary vaccines at the right time to ensure full immunization. Due to vaccinations, most children in developed countries no longer deal with the complications that can arise from mumps, measles, pertussis, diphtheria, and other diseases that they used to. This year, in particular, experts say that getting the yearly flu shot is essential for anyone 6 months or older. Flu vaccines are updated every year to protect against the ever-changing virus. Despite telemedicine availability, health experts say it’s critical to stay up-to-date on vaccines and certain screenings, so they’re encouraging people to keep up with their appointments. Telemedicine is a tool but isn’t a replacement for the patient-provider interaction. Many doctor’s offices have implemented extra steps to make sure patient safety is the priority. No one wants to end up in the hospital because they opted against routine care.
Without a doubt, underlying health issues that are left undiagnosed and untreated can have serious consequences. Preventive care and a healthy lifestyle are the keys to living a long, healthy life. It’s never too late, or too early, to begin preventive health care…it must be a priority. Your health is priceless; don’t put your life at risk!