Getting the most out of your annual medical visit

Transcript

Scott Webb: Annual checkups with our primary care physicians are essential for maintaining good health. But choosing a primary, knowing what’s covered by insurance and how we should prepare for annual checkups can leave us with more questions than answers. And here to help answer some of our questions today is Dr. Kevin Via. He’s a family medicine doctor with Prisma Health.

This is Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. So, doctor, thanks so much for your time today. We’re talking about annual checkups and primary care physicians. And I know that’s something that we all think about and struggle with, is how do we choose a doctor, when should we see them and so on. So, as we get rolling here, why are annual checkups with our primary care physicians so important?

Dr. Kevin Via: Annual checkups give an opportunity to address some of the preventive health items that a lot of times, for lack of a better term, get overlooked when we go to the doctor for say a specific problem, like a a cold or, you know, you sprained your ankle. Or if you have other medical problems that you go to the doctor more frequently for, sometimes some of the preventive health items that you need to address just gets put on the back burner and doesn’t get looked at quite as closely as they often need to.

So it just kind of sets aside a time where you and your physician can take a chance to go over all of the preventive health guidelines that’s maybe recommended for your age and what maybe some of these you’ve already done and some of them that need to be done. And it gives that chance for everyone to prevent medical problems from happening rather than reacting to medical problems, which is a lot of times what we end up doing in medicine.

Scott Webb: Yeah, it does seem like medicine can be a bit reactionary and that many of us only go to the doctor when we have sort of an acute illness or injury. And I kind of look forward to those yearly visits with my doctor, because it feels a little less stressful, like we have a little more time, like we can just kind of talk through some things. Has that been your experience?

Dr. Kevin Via: Absolutely. So it really gives a chance where you can even talk about more of your day-to-day activities such as diet or your exercise or even things that maybe, you know, at work that you could incorporate into living your life a little bit healthier. And a lot of times it is more of a conversation just about what are the things that someone can do to be more healthy or to prevent maybe medical process es developing later in life and whatnot. And of course, there’s some tests then and things that are recommended for that, but it is a lot of times a conversation about, you know, what are the strategies specific for that patient or person that you can incorporate into your day to day activities. There’s things that you do every day that maybe you could do more of or highlight.

Scott Webb: Yeah, definitely. I always find it to be really productive. I always feel good when I leave there. I feel like I had the doctor’s, you know, kind of undivided attention there for that 45 minutes or an hour or whatever it was. But when we talk about the physical exams and actually seeing our PCPs, what’s generally involved with those exams?

Dr. Kevin Via: A lot of people call their annual checkup a physical exam, which is fine. They kind of use that term interchangeably and physical examination is a large portion of that visit. You know, you get to kind of the routine physical exam where we listen to your heart and listen to your lungs, and we’ll press on your abdomen to make sure that it’s soft and don’t feel any lumps or bumps in that area. Generally, we will do a complete skin check. And I always ask if you notice any new moles or changing freckles or things like that, that somebody may have pointed out to you or you yourself noted.

Now, more recently, as far as pelvic exams and rectal exams for men and women, we don’t do those quite as routinely anymore. There’s been some evidence that has come out more recently that prostate exams for men that don’t have any symptoms aren’t quite as useful. And then for women, the recommendation for Pap tests, which is the screening test for cervical cancer, is not done quite as often either. So that now, if you’re below the age of 30, it’s only every three years if it’s normal. And then over the age of 30 to 65, it’s every five years if normal.

So we don’t always do the sensitive exams as yearly as historically they have been done, which kind of gives a lot of ease to some people that might feel a little uncomfortable with that type of exam.  We think it helps people feel more comfortable coming to their annual physical or at least less dread, “What am I going to expect? Is this going to be uncomfortable or anything like that?” So usually, the physical exam portion of an annual checkup is pretty straightforward and pretty quick.

Scott Webb: Yeah, it is. And I can see how that would maybe lower some of the anxiety a little bit for people and maybe encourage more people, you know, to go for those annual checkups or physicals, whatever they choose to call them. Is there anything that we can do mentally or physically to prepare for these visits?

Dr. Kevin Via: I always tell folks mentally think about any concerns or anything that, you know, talking with friends and family and write them down. You know, people always kind of feel a little self-conscious when they pull a list out in the office and they kind of always make an excuse, like, “Well, I made a list. I’m sorry.” Me, personally, and I think most of my colleagues would agree that we don’t mind lists. Lists actually kind of speed things up and make sure we address everything while you’re there instead of you going home and maybe you think to yourself, “Oh, I forgot to ask this” or “Do I need to come back in and talk about this some more?”

If it’s something we can address everything during that one visit, we’ll let you know that. And we’ll say, “Hey, maybe we should shelve this and follow up on talking about some of these issues. But I appreciate when people do their homework and come in prepared with what their concerns are. And if you don’t have any concerns, that’s fine too. You don’t always have to have concerns. But I think that as far as from a mental standpoint, it helps you prepare for that and just be relaxed. None of us are ever going to do something that you’re not okay with or at least we’re going to want to talk to you about no matter what, if it’s just asking a question or a type of test or an exam that we need to do, we always make sure that you’re okay and comfortable with having that exam done, rather than just saying, This has to be done right now or else.” So we just want you to be comfortable and be prepared.

Scott Webb: Yeah. And I think the list is such a good idea. I definitely do that because I found myself for years getting in the car to leave and going, “Oh no, I forgot. I got to ask about this.” So I just started making a list. And I’ve had that experience too, where my doctor said, “You know what? That’s a pretty long list. We’re not going to get to all those things today. Let’s get to the essentials,” right?

Dr. Kevin Via: Exactly.

Scott Webb: And so when we talk about these annual checkups or physicals, are they generally covered by insurance or might there be some services where there would be a fee?

Dr. Kevin Via: So that’s always somewhat of a difficult question to answer, you know, to have kind of a generalized answer for everyone. I would say, as a rule of thumb, most annual checkup visits or preventive health visits are covered by insurance. Some insurances, depending on people’s plans, may have a copay with it. Some don’t have any copays when you have your annual checkup. And a copay is just a fee that you pay when you come to the office and then your insurance would say maybe your fee may be $20 or $50 and your insurance covers the rest. So it kind of depends on the plan.

A lot of the lab tests that we get, so we may check your cholesterol or your blood sugar, we try to do our very best in staying up to date on what insurance carriers will cover what for a preventive health exam. So generally, we don’t run into too many problems with that as well. But as far as other types of tests that we would refer out, for example, mammogram for a woman or a colonoscopy over the age of 50, those also are pretty well-covered preventive health tests, just because the evidence behind doing those tests is so strong that most insurance companies will cover it. Again, the difficult part is you may have a certain percentage that you’re responsible for.

A lot of times, and this also goes back to being prepared, sometimes, you know, contacting your insurance before you come in to ask some of those questions or ask about what would be covered under my annual checkup, they’ll give you at least some type of answer and you kind of have an idea of what is covered and what is not covered. But we always try to be aware of something may not be covered to let the patient know, “Hey, this generally isn’t covered under an annual checkup. We might want to do this at a different time” or maybe we don’t want to do that test.

Scott Webb: Yeah. It never hurts to have the information, as you say, when we prepare for these things. And usually those 800 numbers are on the back of our insurance cards. Never hurts to call, ask, “I’m going in for, you know, annual checkup. What do you cover? What do you not cover?” Right?

Dr. Kevin Via: Right. Exactly.

Scott Webb: You know, I was trying to think back when I chose my primary care physician whom I’ve been with for, geez, probably 15 years or so. And I was trying to think, how did I choose her in the first place? I think I looked online at the doctors who are available in my group, you know, and I saw her picture and she seemed like she had a nice face, maybe a nice personality, read some reviews. But I’m sure a lot of people struggle with this. How do we choose as a primary care physician? Because it does become such a sort of a personal and intimate sort of relationship if you will. And what’s your best advice on choosing a PCP?

Dr. Kevin Via: Absolutely. So it is a big decision and sometimes you go online and it’s just an overload of information where you’re trying to narrow down a specific person to pick that you just get overwhelmed and then ended up picking no one. Prisma Health does a great job of having a section of the website where primary care physicians are listed. You can break it up based on location if that’s important to you. You can also break it up onto if it’s men or female that you prefer to see, whichever provider. They also do a good job with most of us have a video where we talk a little bit about ourselves and what’s important to us as far as why we went into medicine and different things like that. So you can kind of get to know the person in a superficial way before making a decision. And then it has some credentials and things like that because some people it’s important for them to know where someone did their training or things like that.

Other ways find a physician that you want to see for your primary care is just ask friends and family. So a lot of times I get folks that will come see me and say that, “Oh, you see my cousin” or “You see my coworker or my friends that I see every weekend and they really like you, so I decided to come to see you,” which we love. We think that’s great. And most people, they can kind of get an idea of what to expect and if it would fit for them and make the best choice for you. Because you’re right, it is a very close relationship that you develop over many years, and a trust that gets developed with that too. And you want to find somebody that you feel good about and can, you know, be open with and don’t have any question about going to see them about whatever problem may be going on.

Scott Webb: Yeah, because you were mentioning some of the screening, the invasive kind of screening that maybe isn’t as common, but still goes on. And you kind of want to feel like that person doing those screenings is someone that you trust, that you like, that you respect and that’s a difficult thing to do beforehand. But as you say, personal recommendations from family or friends, that probably helps as well, yeah.

Dr. Kevin Via: Absolutely. Yeah. The recommendations I think is if you’re ever looking for any type of primary care physician or a specialist physician that you might want to see or need to see, ask around because people will give you honest opinions and will help you narrow down who and what the type of provider that you want to see.

Scott Webb: Yeah, that’s so true. There’s no shortage of opinions out there on restaurants and doctors and everything else. So doctor, this is a little confusing. Maybe you can clear things up here. What’s the difference between a family medicine, physician and internal medicine physician or a family nurse practitioner?

Dr. Kevin Via: Right. So it can be a little bit confusing. I’ll start with family medicine because I am a family medicine physician. Family medicine and internal medicine physicians, all of us went to four years of medical school. And that’s where you kind of have, you know, general medical training and you rotate through all types of different medicine and things like that. And then we choose what we want to go into.

So with family medicine, it’s a three-year residency training program where family medicine docs can see all ages that’s from newborns all the way up to the very elderly. And they can do office procedures. They take care of general medical problems and basically serve as a primary care physician for the entire family, hence the name.

Internal medicine physicians choose to do an internal medicine residency, which is also three years of training, but they only see adults. So internal medicine physicians do not see anyone generally under the age of 18.  But they see men, they see women, and they do a lot of the same type of procedures and the same type of general medical care, and taking care of patients from that aspect. So that’s probably the biggest difference between family medicine and internal medicine, is family medicine can see children; internal medicine, they do not see children.

A family nurse practitioner is someone that has already had a nursing degree and lots of times they’ve worked in the nursing field for many years, and then they get training to be a nurse practitioner who generally operate under the supervision of a physician. And they also can see all ages. So family nurse practitioners will see kids and adults. Like I said, they’re usually in an office with a physician, but they also operate pretty independently and are very good. And we have a nurse practitioner that works with us and she is fantastic. And we have great confidence in her abilities to take care of her own patients and her own patient panel.

There’s also physician assistants, which are very similar to nurse practitioners. They can have a degree in anything really prior to going to physician assistant school. But they function in the same capacity as a nurse practitioner would.

Scott Webb: Yeah, that’s been my experience, that nurse practitioners are great. And sometimes I felt like with nurse practitioners or physician’s assistants, like maybe I can just be a little bit more open and honest and not be worried about always saying the right thing,

Dr. Kevin Via: They’re a great tool to our medical system and. And like I said, we love the nurse practitioner we have with us. And she’s important and integral part of our team. And she has a knowledge base that we’ll even ask her questions because sometimes we didn’t learn that in medical school and her working as a nurse gives her that experience and information that we can rely on. So we’re all the time asking each other for advice or help or anything from that standpoint. I feel like that’s pretty consistent in most medical offices that I’ve worked in or I’ve had colleagues I’ve worked in.

Scott Webb: Yeah, that’s great that you guys all work together and collaborate and talk through things together. And as you say, nurse practitioners often have a lot of experience and they may just have learned some things along the way that doctors haven’t yet. And so that’s really good. Yeah, it gives the patients a lot of confidence. And, one last thing I have for you, what is the difference between an MD and a DO?

Dr. Kevin Via: Right. The MD stands for medical doctor and DO stands for a doctor of osteopathy. They’re both medical degrees. They have the same requirements coming through training. You have to take many of the same exams or similar exams to graduate and to get certified, and those types of things. The DOs, they do receive additional training in something that’s called osteopathic manipulative treatment. It’s not exactly like chiropractic care. It’s a little bit more research based. But they can do certain manipulations for different types of problems, whether it be back pain or shoulder pain or anything like that.

I will say that a lot of the DOs that I have worked with don’t often continue doing that type of treatment just because they don’t get that much volume doing that type of treatment, but a lot of them still incorporate it into their practice. But as far as training and being qualified to be a medical doctor and take care of patients and to be a primary care physician, there’s really no difference between the two.

Scott Webb: Gotcha. You know, this has been really educational and helpful today. And we started off today talking about annual checkups and physicals and things like that. So as we wrap up here, what are your takeaways? What do you want folks to know about annual checkups? What’s involved, what they can expect, how they can best prepare, and so on.

Dr. Kevin Via: I think the biggest takeaway with going to your annual checkup is to try to make sure you do it every year. Life gets busy. It’s hard to remember when you need to go and, especially with the COVID-19 pandemic this past year, a lot of things got put on the back burner or delayed. And so just trying to catch back up on those.

An easy way to do it, a lot of folks will just come in for their annual physical around their birthday. That’s an easy way that you can remember every year, right? “My birthday is coming up. I need to make sure I get in for my annual checkup with my doctor.” And I think just getting in the room is 99% of the obligation and just taking that step to do that and we’ll help you through the rest of it.  If you’re prepared, that’s great. If you’re not prepared, that’s perfectly fine too, because we’ll still take care of you and make sure that everything that needs to get done gets done to keep you healthy and to make sure you live a long productive life.

Scott Webb: Yeah, that is the goal, long and productive. And that’s such a great tip about the birthday. That’s exactly what I do. Doctor, this has been really great today. Thank you so much for your time and you stay well.

Dr. Kevin Via: Absolutely. Thank you too.

Scott Webb: That’s family medicine specialist, Dr. Kevin Via. And for more information and other podcasts just like this one, head over to prismahealth.org. This has been Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. Stay well.