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VOL. 5 • NO. 9
Checkup
© August 2011
Annual physical exams are integral to overall health — despite the critics The debate on yearly physicals rages on. Are they the benchmark of good health or an expensive drain on the health care system? Dr. Myechia Minter-Jordan, the chief medical officer of The Dimock Center, is clear on her opinion. “It is one of the more key visits,” she said. “It provides an opportunity to focus on the total patient.” While visits for acute complaints average 20 minutes, Minter-Jordan said she devotes twice that amount of time for a yearly physical. “It’s a more relaxed setting where I can address multiple issues,” she explained. But a study published in 2007 in the Archives of Internal Medicine suggests that, for healthy adults, the benefits of an annual physical may not justify the financial cost. Researchers from the University of Pittsburgh School of Medicine and Harvard Medical School found that preventive health examinations and preventive gynecological examinations account for 8 percent of ambulatory visits at an annual cost to the economy of almost $8 billion. The problem, according to the researchers, is that no professional organization has a set policy on yearly exams and there are no established criteria on exactly what that exam should entail. Physicals vary by doctor and even region of the country. They are most common in the Northeast, least common in the West. Some doctors perform a cursory check, while others examine each system of the body and include blood and urine tests. In addition, critics argue, screening tests — the hallmark of prevention and the chief component of yearly exams — can actually be performed at other medical encounters during the year. A visit for a rash,
Mental
for example, can segue into a check for hypertension, cholesterol or even cervical cancer. Yet, supporters of yearly exams contend that they serve a much broader role than just screening tests. They help establish and cement patient/doctor relationships and set the stage for education and conversation in an unhurried environment. Minter-Jordan added that it is not the best time to offer screenings when someone is not feeling well. Regardless of the debate, an earlier study in the same journal found that 65 percent of roughly 800 primary care physicians in Boston, Denver and San Diego agreed that yearly exams were necessary, a sentiment shared by a large number of patients. The federal government has weighed in. As part of the Medicare Modernization Act of 2003, a “Welcome to Medicare” exam has now been added that consists of seven elements, including functional ability and safety. The lack of a clear standard on yearly physicals is not a reprieve from doctor’s visits. Quite the contrary. The need for certain screening tests has been well established. Several professional organizations, such as the American Cancer Society, have developed protocol for prevention or early detection of particular illnesses based on research findings. The ability to stop a disease before it starts or detect it in its infancy is one of the major advances in health care in this country and instrumental in the drop in deaths of many diseases. Cervical cancer rates have fallen as much as 70 percent since 1955 in the U.S. largely due to widespread use of the Pap smear. Women can now find breast cancer before it spreads and a simple, painless blood pressure measurement can Checkup, continued to page 4
health is equally important When most people think of summer, they conjure up visions of picnics, the beach or outdoor concerts. But Dr. Nina Mitra, a licensed psychologist at The Dimock Center, has other thoughts in mind. “Summer’s a perfect time to do a mental health self-assessment,” she said. “There’s more sunlight, more daylight. If you’ve been thinking about recharging your batteries, now’s the time.” Mental health disorders are often overlooked as a component of a yearly physical. Yet, it is not possible to separate mind and body — the two are inextricably linked. “It’s always good to check up to see how you’re doing — physically as well as mentally,” Mitra said. “It’s a healthy thing for everyone to do.” Healthy — yes — but not so easy to do, particularly for some African Americans. Historically, blacks are resilient and so used to hardships, they often fail to see the signs of a mental disorder. They assume that sadness is “just the blues” and a normal part of life. Furthermore, the stigma associated with mental illness prevents many blacks from owning up to emotional problems let alone receiving care for them. Yet, in surveys conducted by the Centers for Disease Control and Prevention (CDC), blacks admit to feelings of sadness, hopelessness and that “everything is an effort” — typical symptoms of depression — more often than whites. Income is a factor as well. The CDC further reports that the lower the poverty level the higher the percentage of serious psychological distress reported among African Americans 18
years of age and older. Such barriers — lack of awareness, poverty and cultural stigma — are factors contributing to the low rates of mental health treatments in blacks and other minorities, as reported in a recent study published by the National Institute of Mental Health (NIMH). Blacks turn to family, the community and religious leaders more often than mental health professionals. Mental illnesses are not rare. More than 26 percent of the adult population in this country is diagnosed with some sort of mental disorder, according to the NIMH, and 22 percent of these cases are considered severe. Common disorders are depression, anxiety, stress and alcohol or substance abuse. And the symptoms can be so subtle, they often escape attention or correct interpretation. Identifying the problem is a big challenge. People tend to view mental disorders in the extreme — the person talking to people only he or she can see, or an alcoholic down on his luck. These indeed may demonstrate mental disorders, but most of the time, the signs are not as obvious. Mitra ticked off several typical symptoms. Depression can result in loss of energy or concentration, loss of interest in things you previously enjoyed, having a negative attitude, a change in appetite. People who are anxious might experience obsessive worrying about something, are irritable, short-fused
Mental health, continued to page