The Interview: Find out about health maintenance.
As the U.S. House of Representatives debates the future of health insurance, after voting to repeal and replace the Affordable Care Act, it’s worth noting that good health comes not just from receiving quality medical care but from stopping disease before it starts. To find out more about prevention and health maintenance, the Orlando Sentinel Editorial Board sought out Meirelys Castro, a primary-care physician at UCF Health’s Lake Nona office. For a full transcript, visit OrlandoSentinel.com/Opinion.
Q: Why should patients visit a doctor’s office when they feel good? A: To me, physical exams are a special time with the patient to focus on self-awareness, preventive monitoring, recommended immunizations, potential emotional problems, appropriate weight and nutrition, cardiovascular risk factor screening and modification, and healthy lifestyle recommendations. You can see it’s a lot to cover and can’t be squeezed into a sick visit — which are sometimes the only time your doctor may see you. For the elderly patient, annual wellness visits are also a great opportunity to explore very relevant factors such as risk for falls, social support, appropriate use of medications, and the ability to perform activities of daily living. A patient who feels good may not think of these preventive services, and a patient who has multiple medical conditions may benefit from a dedicated visit to just focus on prevention.
Q: Most people don’t find the thought of a colonoscopy very fun. How do you persuade people to get it done? A: You’ re right .[ Yet] co lo rectal cancer is the second-leading cause of cancer death in the U.S.; however, about a third of the eligible population have never been screened for colorectal cancer. I tell my patients that the United States Preventive Services Task Force has found convincing evidence that screening for colorectal cancer with several different methods can detect colon cancer at an early stage and adenomatous polyps, which have a potential for becoming malignant. At an early stage, the disease might be easier to treat, or in the case of these polyps, a plan can be made for more frequent screening to decrease the chances of developing colon cancer. It is important to note that in addition to direct-visualization strategies, such as colonoscopy, other very effective stool-based tests can be used for screening.
Q: Are men and women equal offenders when it comes to putting off health maintenance? If there is a difference between the two, and why do you think that is? A: When you look at national surveys or data from the U.S. Census Bureau in previous years, it appears that women were more likely than men to have visited a medical provider. This has also been my clinical impression over the years. However, I have also seen great similarity in their acceptance of recommendations for screening. I believe regardless of sex, a good rapport between patient and physician is fundamental to compliance with any medical recommendation. If a patient knows that a provider will listen to his or her fears or concerns in a nonjudgmental way and will work to find a solution that is desirable or acceptable to that individual patient, it is more likely that the patient will feel comfortable and even look forward to the visit.
Q: Understandably, age is a major risk factor for many illnesses. Is there a certain age where we need to pay more attention to these things? A: When it comes to preventive services, physicians follow a set of guidelines for these services for every age group that provides the most reasonable balance between the potential benefits and harms of screening. However, these are just general guidelines, the most important first step to health maintenance is to have a discussion with your physician about your family history, risk factors and individual preferences, which will determine whether you will benefit from screening at a younger age or if the screening guidelines are a good fit for you.