The Washington Post

Patients should insist that their doctor makes time for wellness measures

Patients may not receive preventive care services due to remiss health professionals or medical missteps. (Melina Mara/THE WASHINGTON POST)

Immunizations, cancer screenings, lifestyle counseling and other wellness measures can save lives. But your doctor may not be making sure you’re up-to-date on the services you need. ¶ In a study published in January in the American Journal of Preventive Medicine, researchers analyzed nearly 500 visits to 64 family-practice and internal-medicine physicians in Michigan. On average, the patients, who were 50 to 80 years old, were due for five to six preventive services but typically received only three. ¶ Doctors missed the chance to do two-thirds of immunizations that were due, more than half of counseling services and more than a quarter of screening tests. Most often missed were flu shots, counseling about aspirin to prevent heart attacks, and vision screening. Eight of 10 patients who qualified for those services didn’t get them.

Wellness gets squeezed

There are several reasons that basic prevention doesn’t get the attention it should. Among them:

It doesn’t pay. Doctors make more money treating problems than preventing them. A 2011 study found that the Medicare program, for instance, paid doctors fully for coordinating and doing only one of the 15 preventive services that the U.S. Preventive Services Task Force considers necessary for people 65 and older.

It’s awkward territory. Doctors often don’t feel comfortable or confident counseling patients about prevention, possibly because they don’t receive much training in it. In a survey that focused on the 2008-2009 academic year, for instance, less than a third of medical schools met the minimum 25 hours of nutrition training recommended by the National Academy of Sciences.

Doctors don’t have the time. Even the best-trained ones would be hard-pressed to squeeze all recommended preventive services into a typical office visit. Add to that the fact that doctors tend to see patients when they’re sick, not well. So rather than being the focal point, wellness gets squeezed into visits when people have a problem.

Taking charge

Assuming an active role is key to getting the preventive services you need and avoiding excessive or potentially harmful ones you don’t. These steps can help:

Find a primary-care doctor who can coordinate your wellness care. And make sure you trust and feel comfortable communicating with him or her. Both are essential for getting personalized advice, encouragement and follow-up. Ask your doctor for help designing a wellness plan that includes diet, exercise and, if needed, weight goals. Make a written list of the preventive services that make sense for you, including a schedule to keep track of dates. You can find a comprehensive table of services to print and share with your doctor at (Search for “checkup checklist.”)

Keep good records. Some doctors give patients online access to a personalized health record, and some research suggests that keeping track this way helps people stay up-to-date on preventive care.

Schedule visits specifically for prevention. A wellness visit every year or two gives you and your primary-care doctor the opportunity to focus on assessing your overall health and risk factors for preventable disease and to offer preventive services tailored to your age, sex and disease risk factors. Medicare now covers a yearly wellness visit to develop or update a personalized plan to prevent disease.

Be prepared. A patient typically gets 10 to 20 minutes of face time with the doctor at an appointment, according to physician surveys and direct studies. Deciding in advance which things you need to discuss can make the most of your limited time. Don’t hesitate to bring a written list so you remember what issues to raise. And consider bringing a relative or friend with you to the appointment.

Think outside the office. Given the time constraints of most doctor’s appointments, some practices have begun shifting toward newer, more holistic care models — including “patient-centered medical homes” and “wellness portals” — in which each patient has a team of providers who stay in contact with them via e-mail, phone calls or classes on nutrition, weight loss or other topics. Office visits are supplemented with materials that the patient can use at home. Even if your doctor doesn’t offer such a model, it’s possible that you can use e-mail to ask follow-up questions or to address problems that arise between visits.

Copyright 2012. Consumers Union of United States Inc.

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