When it comes to your annual wellness checkup, you know the drill. You arrive early, fill out paperwork (again), watch the clock tick by in the waiting room, and then wait a little more in the exam room until you finally have a brief chat with your doctor.
Depending on your history, you may have specifics to discuss, but if not, these check-ups can not only be brief but also … vague. If you look and feel okay, you probably leave with little more than a “see you next year” and perhaps a prescription refill or two. So, what do we do about it?
We consulted with a primary care doctor to hear more about the shortfalls of general wellness checkups, how to make the most of your appointments, and even tips for understanding your lab work.
Shortfalls of Wellness Checkups
Unfortunately, less-than-attentive doctor appointments are the way of modern primary care. Providers are overbooked, bogged down with administrative tasks, and bound by insurance restrictions, making it impossible to deliver the caliber of care patients deserve and most doctors desperately want to provide.
“There’s just not enough time for physicians to devote to actually promoting wellness,” says Dr. Joseph Wu, MD, a primary care physician and founder of Brightmark Health, a concierge medicine practice in Birmingham, AL. “We’re too busy fixing problems as they arise instead of truly preventing them.”
SB Note: Dr. Wu, a concierge physician in Birmingham, AL, is a client of ours. In a recent conversation, he shared insights from his time as a primary doctor in a larger health system, offering valuable tips on how patients can advocate for themselves. These insights align with our mission to provide actionable health advice to our readers, and we wanted to pass his advice along.
According to Dr. Wu, the biggest challenge to a comprehensive annual checkup is time. “Annual checkups typically get lumped in with a regular doctor’s visit, which may also be addressing chronic medical conditions,” he says. “In many cases, the health maintenance items that we need to address are lost in the shuffle or put on the back burner due to other issues that are more acute.”
He cautions that unless the staff is instructed to allot extra time for a particular checkup, the appointment will likely be scheduled in a 15-minute slot.
These time constraints lead to doctors approaching patient care with what Dr. Wu calls a ‘whack-a-mole’ approach. “When [problems] come up, we’re trying to fix them, but we aren’t actually doing a good job of preventing them from happening in the first place,” he says, “or from happening 10 or 20 years down the line. Because we just don’t have time.”
Unfortunately, Dr. Wu says, money is a primary factor. Both private insurance companies and Medicare compensate physicians on a ‘fee for service’ system, so more patients equal more revenue. According to U.S. News and World Report, primary care physicians are compensated less than specialties like dermatology or obstetrics while also requiring more time spent on clerical tasks like refilling prescriptions and reviewing medical records.
Preventative medicine often draws medical students interested in building long-term relationships with their patients, only to face an unappealing reality in primary care. This has resulted in a shortage of primary care physicians across the country.
The Rise of Nurse Practitioners in Primary Care
While the number of primary care physicians is declining, the number of nurse practitioners is growing, with many taking on the primary care provider role. Dr. Wu explains that this can be immensely helpful for physicians operating under the ‘fee for service’ system, provided they work as a team to offer the best possible care for their patients.
“I had two nurse practitioners at my previous practice because there was no way for me to physically be able to deal with 3,000 patients,” Dr. Wu shares. “I had less face-time with the patients … and I missed those relationships.”
Still, Dr. Wu stresses that regular doctor visits, including with a nurse practitioner, offer many benefits. For example, people who go to their checkups can better manage risk factors such as blood pressure and have a lower mortality rate for breast and colon cancers.
The key is making the most of your time with your care provider and becoming an empowered advocate for your health.
Become Your Best Health Advocate
When taking charge of your health and becoming your best advocate, Dr. Wu says an excellent place to start is considering what you want your quality of life to look like 10, 20, and 30 years from now.
“As people in general, we take a short-term view of things,” he explains. “I think patients should be asking themselves what interventions need to be made now to prevent or mitigate the effects of diabetes, hypertension, heart disease, [and] dementia down the line.”
Dr. Wu suggests working with your primary care provider to consider your risk factors and develop a personal health and lifestyle plan tailored to you. He says the ideal role of the primary care physician is to help you realize your health goals over your lifespan through regular health maintenance and preventative care.
How to Make the Most of Your Checkup
Given the modern challenges facing wellness checkups, knowing how to make the most of your brief time with your care provider can be difficult. Many patients don’t know what questions to ask, while others come armed with a laundry list of concerns their doctor won’t have time to address.
Dr. Wu offers two suggestions to help you make the most of your checkup: schedule extra time if needed and prioritize your list by the most pressing and vital concerns.
“You need to make sure that you have enough time to get everything done when you make your appointment,” he explains. Requesting a double appointment can ensure the time you need while also telling your care provider that you have some concerns you plan to discuss.
When it comes to your list of concerns, always start with what bothers you or worries you most and go from there. Even better, email your list to your care provider ahead of your appointment. Dr. Wu says this is a great way to allow the physician to review your concerns and look for patterns or potential diagnoses ahead of time, which will streamline your appointment.
Care Providers Should Optimize Checkups, Too
Dr. Wu also thinks care providers can do more to make the most of their time with their patients. “I think the biggest thing we fail to do during annual health maintenance exams is address lifestyle, such as diet and exercise,” he says. “We may tell patients that they need to exercise more or work on their diet, but we don’t empower them on how to do those things.”
He says that although lifestyle improvements like increased exercise are the most effective interventions doctors can recommend, they spend almost no time on them. This is partly because they don’t receive enough training on discussing them skillfully with their patients and partly because they run out of time.
“I think taking the time to set some simple goals and ask the patients what they are willing to do to improve and extend their quality of life can go a long way,” he advises.
Don’t be afraid to take this advice and ask your doctor what lifestyle improvements you can make. Inquire about their practical ideas on how to implement these modifications or changes.
Know Your Labs
Lab work is essential to helping your care provider comprehensively view your overall health. While primary care providers order labs according to their protocols, you can also be proactive by requesting certain screenings or tests according to your history and risk factors. Dr. Wu provided a helpful breakdown of the most common tests he recommends for routine care:
Tests for routine health maintenance visits:
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (CMP) (includes electrolytes, kidney, and liver function tests)
- Urinalysis (recommended for diabetic or hypertensive patients)
Cholesterol Screening:
- Normal-risk Patients: 35 years for men, 45 for women
- Routine screening every three to five years if results are typical.
- High-risk patients (diabetes, hypertension, strong family history, smokers): 25 years for men, 35 for women
Additional tests to consider for patients at high risk for heart disease:
- Coronary artery score (CACS) CT scan
- C-reactive protein (CRP), apolipoprotein B (ApoB), and lipoprotein(a) (Lp(a)) labs
Diabetes Screening:
- For patients over 35, a fasting glucose test should be done alongside a cholesterol screening.
Colon Cancer Screening:
- Colonoscopy every 10 years starting at age 45 for average-risk patients (Cologuard is also an option but should be done more frequently.)
Other tests to consider based on individual symptoms and risk factors:
- Iron studies
- B12 levels
- Thyroid levels
- Vitamin D levels
- Testosterone
- Sexually Transmitted Diseases (STDs)
- Hepatitis B and C
Addressing Your Health Concerns
Whether intentional or not, many patients have felt unheard and unsupported by their doctors at one time or another. The doctor-patient relationship can be an intimidating one, but Dr. Wu says patients deserve to find a physician who will bend over backward to address their concerns and prioritize their care.
Dr. Wu advises patients to take an honest look at their health and history and then be upfront and direct with their care providers. “When you start thinking through your family history and risk factors, you just have to say, ‘Look, this is what’s going on with me. This is what I’m worried about. What do you suggest that I do?’” he tells us.
If you think it’s time to see a specialist about your concerns, be open and straightforward.
For Dr. Wu, primary care should be a collaboration between the care provider and the patient. “What I’m big on is relationships,” he says. We’re working together for your health, as opposed to an incidental or episodic thing. Because if I have a good relationship with you and you have a good relationship with me, that’s going to yield a lot of dividends down the line.”
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