Dr. Swiner’s Medical Note–Necessary vs. unnecessary medical care

I asked some friends what they wanted my next article to be about and, interestingly, I received two requests – almost the opposite of the other. One friend asked about the importance of regular exams. The other wanted to discuss how NOT important some exams were.

cal exams because of how “healthy” a person can appear on the exterior yet have many silent and deadly disease occurring internally. The second friend commented on how many tests and studies were being discussed as “must-haves,” appearing to be unnecessary on the back end.

I refer back to a November article I wrote on the controversial change in recommendations on mammograms. It centered around the fact of decreasing how many mammograms a women gets and increasing the age at which she starts getting one depending on her history and family history.

Some people thought this was a conspiracy for insurance companies and the government to save and make money. Others were pleased that finally someone agreed that some of these tests are at times unnecessary.

Whichever way you go about it, my main point is always to have an educated conversation with your primary clinician about the pros and cons of any procedure. This includes annual physical exams and tests. My belief is, regardless of one’s health, it is always a reasonable idea to have a yearly checkup as we often find those signs and symptoms of silent killers like high blood pressure, diabetes or heart disease. Other conditions found that may not present with any symptoms are cervical disorders and sexually transmitted diseases.

The flip side of the coin is this: Has it been proven that doing annual physical exams actually help to prevent disease? Some research has shown that doctors are not as great with catching diseases when someone does not have symptoms. The U.S. Preventive Services Task Force is the organization that recommends how helpful screening tests and studies are, and how frequently we should have them done. You may have heard this name recently in the mammogram discussion and the change of recommendations with this study. To reduce unnecessary costs, stress and decrease false positives – meaning something looking falsely abnormal that is not really abnormal – yearly tests on some diseases might not be needed. These would include – for healthy patients with normal results in the past – pap smears, mammograms and cholesterol screening. The recommendation for mammograms was changed to say we only need them every two to three years after the age of 50, except under special circumstances, like family history of cancer.

How about tests like CAT scans, MRIs and such? Are they really necessary all the time? Certainly not. There could be a more efficient, cost-effective and less invasive test or study to do in many cases. However, there’s only one that we know of in the medical world to suffice.

Take the Pap smear for instance. As of right now, we do not have a better alternative to screening for cervical cancer in women. However, that doesn’t mean every woman has to have one every single year. I begin doing pap smears for women either two or three years after first sexual intercourse or age 21, whichever comes first. After a woman has at least two normal pap smears in a row and is sexually monogamous with one partner, I think it’s reasonable to start skipping years.

After a hysterectomy – unless done for a cancerous reason – or age 65, she can stop having paps altogether. But you wouldn’t know that unless you asked your doctor, which one should always do. It all depends on the situation and each individual patient’s risk factors.

Even if you’re not having any tests done, nothing takes the place of yearly checking in with your clinician or doctor to have him listen and feel your organs.

Dr. Swiner is accepting new patients at Durham Family Practice at 220-9800. She is also available for speaking engagements.

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