In the early 1900s health insurance became a reality in the USA; for practical reasons clients had to submit to yearly medical checkups. Although the hint was taken by the public that that should be the golden rule, and was subsequently endorsed by the American Medical Association in 1922, it is being contested nowadays. The American Medical Association, US Preventive Services Task Force, and the Society of General Internal Medicine no longer promote the yearly head-to-toe examination in symptomless, healthy adults.
So when to see the doc?
There are two groups of people: those in good health and those who are not. The former could skip seeing his doctor too often though a five-year visit would be reasonable. As for the latter group we can tentatively narrow our search down by analyzing the factors affecting health and act accordingly.
1. Age: People at the extremes of age should logically have medical check-ups more than young adults. Kids must have their vaccination as scheduled. Senior citizens, after complying with the annual anti-flu vaccine schedule, would do well to arrange for regular visits if they have medical problems or chronic diseases. The doctor would fix the next appointment himself or herself. In the USA ‘mammograms, for example, are generally recommended every two years after age 50’.
2. Family history: How about the influence of our genes? If our family members generally live beyond 90 then, in theory, someone of 60 – and in good health — may have less need for a check-up than his peer in a family that rarely live beyond 65 years. And where both parents are diabetic or hypertensive, then the siblings would do well to be on the alert, and consult doctors earlier than those who are not so affected.
3. Standard of education: Someone who has had a very modest education, who indulges in smoking regularly, abuses alcohol and puts on weight may feel well but it would be unwise to imitate the more educated who is not so afflicted or addicted. We expect the more educated to have a better approach to their health than the less educated, so the frequency of their rendezvous at the clinic would be different. The latter would not feel the need for check-up until disease strikes, while the former would adhere to some prevention scheme.
4. Financial income: And could we expect the less well to do to go to the doctor more often than the richer? Free public medical facilities are available, but generally a low income combined with a lesser education come to compound the situation. It is often noted that the less educated does not make use of facilities put at his disposal by the national authorities. Many come to hospital with severe anaemia, uncontrolled diabetes or hypertension, which should have been taken care of at primary care level at an earlier stage; they find reason to ignore this call. Again the stubbornness to neglect one’s own health is a paradoxical behavior, couched in psychological complexes. Having a welfare state which provides free facilities for better health may not be sufficient; the level of education of the individual will determine his aspiration for better health and preventive medicine.
Of course the down trodden – with no food or water facilities — would not consider health as a priority.
5. Physical activities: Those of us who indulge in regular exercises would, in general, be enjoying better health, having a better sleep pattern and being less stressed. Those who do not are more prone to diseases and hence, in theory at least, should consult their physicians earlier than the former. And the stress of modern life exposes us to more psychological and cardiovascular risks.
In general, agricultural people reaching the 7th decade could not be models for its modern members who are now urban dwellers with all sorts of stresses, and thus prone to more diseases. As our society changes environment, becoming more industrialized, frequenting more fast food outlets (the more fast food is being decried, the more they are flourishing!), as more pollution of all types (chemical, dust, noise) is invading our life, we may expect our health and our immune system allergy to be affected negatively and be different from our ancestors. This may entail the need for more frequent visits to the doctor.
But what to say of the news coming in that young adults in their 20s have been diagnosed with coronary problem, and with cancer of breast specially? Could they have been screened earlier? Is it feasible to ask youngsters to see their doctor early? Most probably not. But how to screen them in time? Again family history should be the criterion to rely upon to make the trip to the health provider. Not everyone is rich and bold enough as Angelina Jolie to decide to have bilateral mastectomies as a preventive measure as her mother and aunty had breast cancer.
Though medicine is a science there is a lot of uncertainty: the patient being that uncertainty! Each individual is unique. His gene, his environment, his immune system, the various thresholds (of pain, fear, adaptation, suffering, vomiting) plus his mental and physical stamina: all that determines how, when and where he will fall sick. Must he see the doctor only when he is ill, or before? Must he consult him even when he is well, at regular intervals or leave it to his whims and fancies? Must we not discover our disease as early as possible and face the music, or should we go on hiding as the ostrich out of fear of discovering the hard facts of life?
Pain, a small mass appearing on the body, a change in function – l such as stiffness of a joint, swelling of legs, shortness of breath, or its worsening, prolonged sleep problem, unexplained tiredness, palpitation – are some of the signs and symptoms that should ring a bell in our mind and send us to the doctor’s surgery.
Is not prevention better than cure? And how to prevent bad health from catching us unawares?
How many of us can claim that we could go through life without being afflicted by a serious health issue? When will that happen? Can we anticipate it – and beat it by going to the doctor well before? Those of us who can afford may decide to see the doctor regularly, have peace of mind and feel safe. Some people like this approach, having someone to listen to their unfounded worries and to provide psychological relief.
Dr Cathy Handy, a public health officer from Johns Hopkins School of Medicine outlined when to start thinking visiting the health provider by asking oneself some questions:
1. “When did I last see a doctor?” If we cannot remember, then it is too long back and it is high time we make the journey to the man in white.
2. “Has anything changed since I last went to the doctor?” We always like to procrastinate; something has been bothering us – the pain in the stomach, a mole getting slightly bigger; then it is high time to go.
3. “Have we forgotten the time interval the doctor asked us to come for review?” Women going for the Pap Smear for cervical cancer, may decide according to their age whether they can skip their appointment or not, depending on whether the last result was negative or positive. It is a question of logic.
4. “Was there something I wanted to follow up on with the doc” — this applies for the borderline result of the diabetes (prediabetes) or the borderline high blood pressure or weight gain. The recommendations of the doctor did not work or you could not keep up with them; so it is time to return and find out.
5. “Has my family history changed recently – someone has had a colon cancer in the family?” This may influence the timing of our next visit to the surgeon.
And don’t use that cynical joke as an excuse to avoid the man in white: “The doctor felt the purse of the patient – and said nothing can be done for him”
The non-profit organization – the Cochrane Collaboration – whose objective is to scrutinize medical research worldwide, reviewed the effect of “general health checks for reducing illness and mortality” during 14 clinical trials involving 180,000 people. The finding was: “The check-ups had no effect on hospital admission rates, absences from work, disability, specialist referrals, additional doctor visits or even patient anxiety. They didn’t improve patient health or reduce mortality, and the review concluded the checks were ‘unlikely to be beneficial’.”
Dr Rajagopala Soondron