Screenings, Annual Exams Key To Health Care

Car owners don't hesitate to take their vehicles for routine maintenance. Dr. Scott Estes wishes people had the same interest in maintaining their bodies.

"Patients are very good about following scheduled maintenance for their cars, for their houses," said Estes, an internist at Mercy Clinic Bella Vista. "They just aren't as good about taking care of themselves."

Vehicles have lights that remind drivers to change the oil, check a filter, rotate the tires. It's an easy reminder and can be hard to ignore.

The human body may use an ache or a pain to remind someone to go to the doctor, but human nature often leads down the path of "shake it off," according to health care providers.

Estes said people are accustomed to being reactive and not proactive with their health, and while that's starting to change, more needs to be done. Routine physicals and screenings are key components in preventative medicine, he said.

"We've always been reactionary," Estes said. "We are not rendering health care, but disease care."

Dr. Cheryl Hennigan, family practitioner at FirstCare North in Fayetteville, recommends everyone have a family doctor and visit him once a year when they aren't ill. She said annual exams give a patient the opportunity to talk about things that could easily be overlooked during a doctor's visit to treat an ailment.

"Be upfront and decide with your doctor what the most pressing things to address are," she said, adding it is not uncommon for people to have a fear of going to the doctor.

Recommended Tests

A handful of health screenings also can help dictate a person's health care needs. Many suggested screenings are covered by insurance.

Dr. Michael LeFevre, chairman of the U.S. Preventive Services Task Force, said preventative care started gaining traction in the 1990s after insurance companies began covering some screenings. LeFevre is a professor at the University of Missouri School of Medicine and a practicing family doctor. He has served on the task force for 10 years. The group is an independent panel of primary care providers that makes recommendations on clinical preventive screenings, counseling and preventive medications to primary care physicians.

LeFevre said recommendations are based entirely on medical literature and weigh the benefits and harms of each screening.

The federal Affordable Care Act requires insurance plans sold to the public provide certain preventative services, such as colorectal cancer and blood pressure screenings, at no cost to customers.

Insurance companies can decide what screenings not required under the health care act to cover.

"We don't consider costs or insurance coverage with our decisions," LeFevre said of task force recommendations.

Insurance companies often rely on task force recommendations to decide what screenings they will cover. LeFevre said the board tries to update each recommendation every five years.

"As technology evolves, new opportunities will arise for trying to prevent illness rather than just treating after it becomes symptomatic," he said. Once a patient shows symptoms, a screenings shifts from being a preventative service to a diagnostic one.

Tonya Nations said she has always been a strong believer in getting annual exams. That belief was validated after a screening mammogram caught her breast cancer in its early stages, said the 59-year-old Prairie Grove resident.

"The cancer I have is so fast-growing and aggressive," she said. "If I had not had my annual mammogram and waited another year it could have been a stage 4 cancer." Stage 4 means the cancer has spread to other parts of the body.

Nations just finished the fifth of six rounds of chemotherapy, and she still needs to complete radiation therapy.

"I believe there are things you need to take care of so you aren't surprised later on," she said of screenings and yearly exams.

Missing Consensus

The task force isn't afraid to recommend against services and knows recommendations can stir controversy, he said.

One example is the task force's 2012 recommendation against PSA-based screening for prostate cancer. Evidence shows a substantial percent of men with asymptomatic cancer detected by PSA screenings have tumors that either will not progress or will grow so slowly they will never cause problems. PSA screenings led to over or misdiagnosis, according to the recommendation.

Estes said he tells his patients about problems that could arise from a faulty PSA test, but said most patients still want the screening.

"A negative test carries more weight than a positive result," he said, adding a negative test gives a patient the all clear sign but a positive result means more tests. "Screenings are a tool that need to be used wisely."

Hennigan said in some situations, treatments for a disease can be worse than the disease. A positive PSA test could result in treatment affecting urination and sexual activity in a disease that wouldn't have gotten worse, for example.

"Anything you do medically carries a chance of complications," she said.

Primary Care

Knowing what needs to be done and when can be a daunting task for patients, and having a primary care physician can help the process run more smoothly, Hennigan said.

"The role of a family doctor is they get to know the whole family and can tailor care to the family's needs," she said. "You learn their family history and can help them get the screenings they need."

Hennigan is Nations' family doctor.

"I depend on my doctor to keep me up to date on what screenings I need to be aware of for the next year," Nations said.

Health care providers are also helping patients keep track of screenings.

Northwest Health System started a health coach program at a few clinics last year and expanded systemwide in January, said Christy Walter, a registered nurse and head of Northwest's health coach program.

Mercy runs a similar program.

"We make sure patients have had all their wellness issues taken care of and response has been good," Walter said.

Northwest assigns a health coach to each patient, and Walter said they try to help them any way possible -- from making appointments to getting prescriptions filled.

She also stressed the importance of having a primary care provider. Having a family physician means someone will have all the baseline information on a patient, such as blood pressure, and will recognize when something is out of whack, she said.

"When people ask why they need a primary care physician, I ask them if they take their car to any old mechanic when they break down," she said. "It always amazes me that people take better care of their possession than their own body."