Dr. Nicole Ascanio, aspireMD, Omaha, NE
Most people are aware that they should see their doctor for an annual physical exam, but few people know what this visit should actually entail. This visit is sometimes called a “wellness visit” because it should happen once a year when you are “well” and not needing to be seen because you are sick. This allows the visit to focus on preventative medicine and keeping you healthy. The current state of healthcare is to fix a problem when it occurs, but for me, the goal of primary care is to keep people well and prevent the problems. These visits should be at absolute minimum 30 minutes (of one-on-one time with your doctor), but preferably at least an hour. Why so long? There is so much to go over during these visits without even taking into consideration any of your established heath conditions. Most patients do not get this long of a visit with their PCP because their doctor does not have time.
A good annual physical should include a review of your history (medical, family, and social history) every single time. This information changes year-to-year and impacts how to best direct your care. Your medications, habits (nutrition, exercise, sleep, substance use), and mental health should also be addressed every single time. While reviewing this, your doctor should be working with you to identify areas needing improvement and how to enact change. Simply telling someone to eat a healthy diet and exercise is not effective. Optimizing your diet, exercise habits, sleep and mental health is the #1 way to prevent chronic disease and to increase your lifespan and healthspan. This is the bread and butter of primary care, but most patients do not get this education and management because their doctor does not have time.
This is also the time to address age-appropriate preventative screenings such as mammograms, colonoscopies, and lung cancer screenings as well as make sure your vaccines are up to date. These recommendations are guideline-based but medicine is sometimes more of an art than a science. Someone who has a strong family history of colon cancer needs to start getting their colonoscopies at an earlier age than the average person. While using colonoscopies as an example, it is also worth noting that these guidelines are not set in stone. They change with new data and studies that come out just like the rest of the medial field.
No longer is it recommended that we wait until 50 to start colon cancer screening. Given the increased prevalence of colon cancer in younger adults, it is now recommended that we start screening at 45. Your primary care doctor should be able to guide you through appropriate screenings based on your age and risk factors. I have seen certain screenings get missed for many reasons – the patient didn’t understand what the doctor was ordering/didn’t understand what they needed to do to get the test done, the patient forgot and no one realized it, the doctor was still following older guidelines, etc. These little human errors are usually all corrected when the doctor has enough time.
Finally, your annual physical is an opportunity to get lab work to assess your current state of health and identify early abnormalities that should be investigated further (as much as lab tests enable us to do that). This was one of my biggest sources of frustration while in corporate medicine. When patients would come in for the annual lab work, I was essentially bound by what insurances deems “covered” because they would otherwise deny it and place an arbitrary price on it for the patient to cover. Unfortunately, this tends to be based on cost/benefit assumptions and subpar data while also assuming every patient is the same and should get the same tests.
There were a handful of more “advanced” (I will use that term loosely because they really should not be considered advanced, but instead standard of care for everyone) labs that I felt were pertinent to a true comprehensive and personalized annual exam. As I have shifted my practice to direct primary care, I am able to get an extensive annual lab panel on my patients that includes evidence-based data that is much more in-depth and actionable compared to what I was ordering before.
What is the cash price for such a personalized, comprehensive, advanced and actionable set of annual labs? About $40.
You might be reading this and thinking back to your last physical exam and looking at everything that might have been lacking. I do not write this to put down other primary care doctors – virtually every PCP that I have met is doing the best that they can under the constraints placed on them. I was a PCP in a hospital-owned outpatient clinic. We had 20-30 patients that we needed to see every day and patients were booked in 15 increments (30 minute for physicals). What people do not realize is their appointment time starts when they check in and most appointment times are over before the doctor even enters the room. Studies show that face-to-face time with your doctor in this setting is 5-7 minutes. I was not able to address even half of what should be addressed in this setting (let alone get to all of the questions or concerns the patient brought with them). I just did not have the time.
Now that I am the owner of my direct primary care practice, I no longer have to take care of patients under some (non-physician) administrator’s productivity schedule or abide by what the big box insurance company deems appropriate for their wallets…I mean patient care. I can put all of my energy and focus into just being the doctor and providing patients with true personalized and comprehensive primary care. I have the time to give directly to my patients as well as the time to stay on top of the latest medical information to directly improve their health and wellness.
Do not be afraid to ask for more time at your next annual physical. This is where the most impactful changes in your health often happen.
Dr. Nicole Ascanio owns aspireMD, a direct primary care practice in Omaha, NE. She started aspireMD to follow her dream of truly helping her patients improve their health and wellness in a convenient, personalized way. Learn more about her and her practice at www.aspiremddirect.com