For many years, you couldn’t use your health insurance for a check-up. The attitude of health insurance companies was essentially that they were available when you got sick, period. But if you were just fine? “Don’t call us.”
To make their point especially clear, if you did visit your doctor for a check-up and she diagnosed you as “healthy female” and coded the insurance claim as “well person examination,” your claim would be denied and on the bill you’d read the now-familiar phrase “not a covered benefit.” To fight back against this tidbit of corporate greed, doctors would routinely submit check-up claims with innocuous diagnoses the patient might have had in the past, like “menstrual cramps” or “sore throat,” so you wouldn’t get stuck with the bill.
In recent years, this has changed…a little. The insurance companies discovered that prevention pays off in the long run and today a reasonable health insurance policy usually includes a so-called wellness exam you’re entitled to annually. They’re quite strict about the once yearly stance—arrive a month early and you’ll pay for the thing yourself.
While this is an improvement, it’s a pretty lame one. Everything considered, you don’t get much in a wellness exam. It starts to look like just another buzzword, like “HMO” (health maintenance organization) having absolutely nothing to do with maintaining health.
If you’ve never used your wellness exam benefit, here’s what happens
After you’ve updated your health history questionnaire, you’re given a physical exam of variable quality by an MD, DO (doctor of osteopathy), physician assistant, or certified nurse practitioner. The examiner reads through your questionnaire, asks a couple questions, and then asks if you have any problems that need to be addressed. If you say “No, I’m fine really,” you’ll be directed to the lab where a technician will draw blood for a blood count, a metabolic profile (which checks for diabetes, liver and kidney disease, and electrolytes), and a cholesterol test. You’ll leave some urine and you’re out the door. If you pull out a list of problems, you’re usually rescheduled for follow-up visits.
Most patients report they never hear anything until their next wellness exam a year later (“I guess no news is good news”) and rarely get copies of test results. In surveys during which wellness exams were timed, most busy offices finished up in less than 15 minutes. Since two thirds of us are overweight, there’s a good chance the only piece of advice you’ll hear is “Better keep an eye on that weight,” which of course you knew before you made the appointment. But you’ve got the satisfaction of thinking, “Well, I seem to have passed my wellness exam. I must be reasonably healthy.”
Not to spoil your day, but you’ve also heard of people falling over dead weeks after a perfect exam. Or instead, and far more commonly, as the years unspool and you continue to get annual exams, you find yourself slowly but steadily deteriorating. Your weight and blood pressure inch upward, your pre-diabetes becomes diabetes, or your occasional low back pain gets worse. You find yourself taking one prescription drug, another, and maybe a third, all the while faithfully getting your annual exam.
“What happened to me?” you might wonder, “I was getting my wellness exams and everything seemed fine.” This isn’t unusual. Frankly, annual exams provide a false sense of confidence. The various tests didn’t find any specific disease, so you assumed you were doing everything right. But normal test results obtained during a single doctor visit are far from a guarantee of long-term good health. There’s much more to it.
So here’s my suggestion for staying well while significantly increasing your odds for life-long health. First, rethink your role as a health care consumer, from one of passive recipient of an annual exam to proactive organizer of your own life. Rather than placing your health in the hands of a busy doctor who sees you a few minutes a year, create your own team of health care practitioners, with you as the captain. Your team might include:
A family practitioner or internist You really should have someone to call if you get sick, a name to hand the registration clerk if you land in an emergency room, and someone to renew your birth control pills, fill out various forms, and coordinate care among specialists should the need arise. If you’re under 60, consider yourself healthy, and your tests have been normal, you don’t need an annual wellness exam. Every three to four years is fine. I don’t believe healthy women need to see an ob-gyn. Most family practitioners and internists do breast exams and Pap smears, but this is your choice. Midwives are a good choice for Pap smears, too.
A chiropractic physician should be on everyone’s team. The musculoskeletal system is often the first to cause problems (injuries, wear and tear) and your chiropractor can perform a thorough check on all this (completely different from your family practitioner, by the way) and point out areas that may need preventive or rehabilitative exercises. An ancillary practitioner here would be a massage therapist. The long-term benefits of regular massage (monthly, for example) to overall health are well known. And you’ll certainly feel emotionally and physically much better after a massage than you would after visiting your internist or gastroenterologist.
Since so many chronic illnesses are related to what we eat, just about everyone can benefit from a couple sessions with a clinical nutritionist, who can review your eating habits, suggest improvements, and show you how to shop for food. Well-meaning vegetarians often have vitamin deficiencies and lots of people think a half dozen diet soft drinks every day are a helpful way to control their weight. If anyone on your team has the potential to add a decade to your lifespan, it’s a nutritionist.
In an earlier health tip, I wrote about the results of an extensive survey tracking the link between health and physical fitness. Let me be so bold as to assume that you, personally, are of average physical fitness, or even a bit below average. If that’s the case, a permanent non-human member of your team should be a health club membership, and a temporary member should be a personal fitness trainer to get you started on a program you can continue on your own. Find a health club convenient to your home or work (mine is halfway between the two so I have no excuse), schedule with one of their staff trainers and say, “I want to get fit. Please show me how.”
Although the AMA would soundly disagree with me about this next team member, there’s quite enough evidence for the existence of subtle energies and their effects on the body-mind connection. In fact, virtually every health care system around the world except conventional drug/surgery-based Western medicine believes in the effects of subtle energies. Whether it’s the qi (pronounced “chee”) of traditional Chinese medicine, the Japanese “ki”(as in Reiki), the chakras of Ayurvedic medicine and Healing Touch, or the vital force of homeopathy, caring for your energetic system is essential and I’d suggest adding one of these practitioners to your team. The easiest and most accessible for many people is someone certified in Traditional Chinese Medicine (TCM). No shortage of patients are seeing a TCM practitioner for maintenance therapy when a minor health problem develops, even before they schedule with their primary care physician. Others see a homeopath, including Queen Elizabeth and before her the Queen Mum, who made it to 103 with a homeopathic physician.
Other health team members seem obvious. You should see a dentist, an optometrist, and, every five years or so at any age but especially if you think your hearing has changed, an audiologist. If you’ve had some emotional issues and feel you need someone to talk to, having the name of a good psychologist is helpful too. More and more, patients are using psychologists the way they once used a trusted older family member, spiritual adviser, or friend–to help out during a stressful life situation. You can set up an appointment or two with a psychologist, see if there’s a good fit, and say something like “I might not need you this instant, but I’d like you to be there.” She’ll understand immediately your intent.
What you really don’t need is a bevy of different physician specialists to check your health on a regular basis. Studies have shown that this fragmentation of care reduces overall quality. Specialists have two toolboxes–prescription drugs and surgery–and individual specialists rarely track the treatment you’re getting from others. If you have a chronic condition that requires the expertise of a specialist, then of course you’ll need that person on your team. But to have check-ups by different specialists will ultimately work against you.
By the way, don’t think this kind of care will bankrupt you. Many of these practitioners are covered by insurance. If you don’t have insurance now, you will when the Affordable Care Act goes into effect.
Physicians, chiropractors, psychologists, and a hearing check by an audiologist are covered by most policies. A growing number of insurance companies are covering acupuncture and massage when prescribed by a physician. Homeopathy and Healing Touch are virtually never covered, but both are usually quite reasonably priced. Same goes for a couple hours with a personal trainer. Virtually anything not covered by insurance can be reimbursed from your Health Savings Account if you’ve got one where you work.
If you want a real and useful wellness check that will actually help prevent illness and maximize healthy longevity, consider yourself captain. Get your team in place. And if you want my advice on where to begin, I’d recommend starting with nutrition and fitness.
Take charge and…
David Edelberg, MD