Ask Us Anything About … Wellness Visits

Screen opens inside a private clinic room where two male individuals are sitting next to each other in front of medical equipment attached to the wall. Sitting on the left is Dr. Bill Curry and on the right is Scott Gilbert.

Scott Gilbert: Welcome to the first installment in Ask Us Anything About from the Milton S. Hershey Medical Center. I™m Scott Gilbert and I™m joined today by Dr. Bill Curry. He™s a family medicine physician here. Thanks for taking the time Dr. Curry.

Dr. Bill Curry: My pleasure.

Scott Gilbert: Today we™re going to be talking about wellness visits. We™re calling this particular episode Ask Us Anything About Wellness Visits. It™s a kind of a springboard off of last week™s Penn State™s Medical Minute when we focused, with Dr. Curry, on a lot of key things to keep in mind about wellness visits, physicals, whatever you want to call them. But basically there are those checkups where you go in to see the doctor, perhaps once a year and try to just get the overall view of your health, just to see kind of, from head to toe, how you™re doing. And also we™re going to be talking today about how these conversations and how these visits with doctors are changing to include things like family history, lifestyle discussions, and you know more than about just checking your vital signs and sending you on your way. So we™re here to talk about that with Dr. Curry and I guess a good place to start would be how wellness visits are changing. How are they moving away from what we think of as that traditional kind of quick exam, conversation, some blood work, and then you™re on your way?

Dr. Bill Curry: Yes, years ago we would schedule, we would ask patients to schedule for a physical examination and as part of that we would perhaps ask them to get some laboratory work. Used to be we would ask them to get a chest X-ray, maybe some other testing. But over time, studies have shown that it really, for most patients, it doesn™t make a big difference in their outcomes of care, it doesn™t change their missed time from work, their illness burden, the risk of being in the hospital. So we scratched our heads and say, Why? and How can we do things differently? And so what we have tried to make a focus on with these wellness visits is looking at the individual and based on their own personal health history, their family history, perhaps their social history, their work experience, their personal habits, trying to define a care plan for them to keep them healthy through the years.

Scott Gilbert: OK, so it™s about developing a real comprehensive peer plan, probably getting to know them more so as a person rather than just checking things off of a list.

Dr. Bill Curry: I think that™s a great way of saying it, yes.

Scott Gilbert: Thanks. The Medical Minute last week, again we referred to, was about wellness visits, the Penn State Medical Minute. You can find that online at pennstatehealthnews.org. And the other thing I™d like to mention is that throughout this conversation feel free to use the comment field on Facebook, if you™re watching us live, to ask us some questions and we will pose those questions to Dr. Curry here. And that includes after the fact, too, even if you™re watching a playback version of this video, we will pose those questions to Dr. Curry and post those responses in the comment field to respond to you if you™re watching as after the fact. In the Medical Minute last week, you mentioned that wellness visits tend to happen most often at the bookends of life, especially the very young and then the rather old, right?

Dr. Bill Curry: So our newborn, children, our adolescents, we think it™s really important to understand their health needs and their preventive health needs, their immunizations, and to have very regular visits early in life and through their childhood and adolescent period is very important. And as they grow older, the purpose of those visits will change and they™ll be a lot of what we™re going to call anticipatory guidance, you know how do we keep our children safe? You know when they™re toddlers you know are they at risk for running out in between cars at the parking lot and how do we keep their safety there? How much time are they spending on the television or other screen time? And is that interrupting their reading time and other learning opportunities? As they get older, safety issues such as wearing their helmets when they ride their bicycles, when they™re on a boat do they have their life jackets on or if they™re near the water are they™re being protected with their life jacket?

Scott Gilbert: Because accidents are such a big cause of death for younger viewers.

Dr. Bill Curry: Absolutely, the leading cause of injury and death in this age group is by accidental means. As our children age and they get into the realm of driving, we spend time talking about safe driving and use of medications while driving. And you know we think about medications as prescription but many of our over the counter medications that we would use to treat things like colds and allergies can cause drowsiness and put them a risk. And so we spend some time trying to talk to them about that. We like to talk about the issues of you know their developing sexuality and talk about their thoughts about that and give them some anticipatory guidance about safe sex practices. And talk about some of the dangers that they™re going to encounter is as they head into the workforce, or going off to college with alcohol use and control exposure to drugs, and so that age group is really important as giving them anticipatory guidance, instructions, encouraging it as they move through those years. In the later years, we spend time with our patients, especially in the Medicare population, and in our older group about understanding, again, safety risks. Do they have the vision and hearing to be safe drivers? Have they had falls? And you know to try to prevent a fall is huge. Every time a person falls and has a break of a hip, there™s a 25% chance that they™ll die from that. And so what can we do to understand what the risk factors are and to change them? Are they getting their immunizations? Are they going to be as well protected against pneumonia, for instance, and they getting their cancer screenings that they would have recommended to them?

Scott Gilbert: All very important things to consider. So we™re talking about the very young and perhaps the elderly getting in for those visits. But those in their 20™s, 30™s and 40™s, the numbers kind of dip there, do we know why?

Dr. Bill Curry: It™s a tough group to sometimes engage in health care if they™re well. Many of them lack the insurance coverage to have the visits partially paid for or paid for. When we™re young, we have this sense of invincibility you know, I™m not going to get sick you know I™m going to be well but you know I think to be able to capture a visit with these folks and understand what their risk are and if their risks are low, perhaps we only need to see them every 5 or 6 years. But if they™ve got factors, if there™s family history, if there™s you know things that happen with their recreation or things that happen at work that put them at safety risk, how can we help them to be as healthy and be as safe as possible?

Scott Gilbert: In terms of the barriers, how often do you think things like insurance are a barrier for people to seek wellness visits at those ages or is it simply a matter of these are busy people you know that™s entered their 30™s, they may become parents and we all know how busy parents can be in our 25 hours a day. So is that really the issue? Is it you know access to insurance or is it really a mix of issues there?

Dr. Bill Curry: I think it™s a combination. I think it™s probably equal for both of those reasons that you talked about. I think there are parts of our country where access to primary care is challenging. And so they™ll seek health care at what™s available, the emergency department or urgent care center, but they don™t have good accessibility to a general internist or a family physician to be able to do the health maintenance.

Scott Gilbert: If you™re just joining us, you™re watching a Facebook live interview here. We call this Ask Us Anything About Wellness Visits. The first in a series of episodes designed to provide you with health information from Penn State Health Milton S. Hershey Medical Center. I™m Scott Gilbert, this is Dr. Bill Curry. He™s a family medicine physician here at the medical center. And as our discussion goes on, we invite you to join the discussion by adding your comments to the comment field here on Facebook especially if you™re watching this interview live. If you™re watching it in playback, that™s fine as well, you can also add your question to the comments and we™ll respond to you in the comments. But if you ask a question during this interview we™ll try to pose that to him here in real time. When someone heads to the doctor™s office for a wellness visit, it™s very important for them to obviously have a good grasp on their own health history. But it™s also important for them to know about their family™s health history, why is that?

Dr. Bill Curry: So as we go through our life journey many of the things that we™ll deal with in terms of our health are determined by our genetics. And we can get a glimpse into perhaps our health history and our health journey based on how our family and our ancestors have gone through their journey. So to understand about cancer history, heart history, high blood pressure history, other illnesses such as inflammatory bowel disease or inflammatory arthritis problems, to have that knowledge of not just your parents but their siblings and their parents, might give me as the family physician, a little different view on how I would plan out their health maintenance visits today and into the future.

Scott Gilbert: Is this, in your experience, information that people do commonly come to the office armed with or is this health information really a third rail topic in a lot of families, something that isn™t discussed around the dinner table?

Dr. Bill Curry: Many of the items are not discussed and if they are discussed there are discussed in very little detail. Now you know Aunt Millie had cancer. Well what kind of cancer did she have? Well she had liver cancer. Well, primary liver cancer is not very common but metastatic cancer to the liver from the colon or from the breast could be an issue that might make me think differently on how I™m going to care for you. So the detail is important but sometimes there™s no discussion at all in families.

Scott Gilbert: Are there certain issues, I™m sure there are, that people as patients are afraid to bring up in a visit? And how do you as a practitioner try to draw those out, try to create that zone where the patient feels safe and knows that that™s not only a time when they can but when they should bring those things to the forefront?

Dr. Bill Curry: So some of the issues around lifestyle can be difficult to discuss with your provider. Smoking is becoming less and less of a social acceptable behavior in many parts of work environments and so not letting your provider know that you smoke or used chewing tobacco might be something that you know I need to know about, that™s important. Alcohol use, either experimentation or regular use with recreational drugs or prescription drugs, I think is sometimes very difficult for people to talk about yet extremely important for their conversation to be well. So sometimes issues about their sexuality and their practice of their sexuality, it™s really important to know about that so I can help to keep them well and protected and sometimes those are difficult conversations to have.

Scott Gilbert: You™re watching Ask Us Anything About Wellness Visits. This is the first in a series of episodes here through Facebook live conversations through which at Penn State Health Milton S. Hershey Medical Center, we want to share information with you, our online audience, and provide you with the opportunity to ask questions as well. So you know if you should have a question, feel free to share that in the comment section. Even if you™re watching this program after the fact, after it™s live, we can still respond in the comment field with an answer. We are talking with Dr. Bill Curry from Family Medicine because he was interviewed for last week™s Penn State™s Medical Minute on this topic of wellness visits. And it was in that medical minute that you mentioned, Dr. Curry, even people who see physicians frequently for treatment of chronic illnesses should still get in for the wellness visits and they might think Well we™re exempt from this you know because I see the doctor so often why one more appointment? But that is important you say.

Dr. Bill Curry: We believe it™s very important. So in the course of our visits for their diabetes or their hypertension or their congestive heart failure, we focus on those chronic illnesses. Sometimes they™re an acute flare and it™s very easy to move through that point and a time just dealing with one or two really important issues and you do that 2 or 3 times and the year has slipped by and you say, Whoa, we didn™t attend to your immunizations schedule, we didn™t attend to your cancer screening schedule. So to have that time that™s just for looking at you as a whole being, spending time reviewing the family history, the social history, your medical history, your medications, is really important so that we can make a plan for the future to keep you well.

Scott Gilbert: Patients, now more than ever, are being encouraged to become more active participants in their own healthcare, as we™ve touched on a little bit in this interview already. But it seems like one way in which that™s easier than ever is through technology such as the electronic medical record. Can you talk about some opportunities that are there for interacting with patients, for engaging patients through the EMR and other technological means that maybe weren™t there 10 or 15 years ago?

Dr. Bill Curry: Yes, I think the electronic medical record holds real power in terms of helping us to keep well, both you know from my perspective in taking care of my patients and my perspective of taking care of me. So when we come to the physician and they or the nurse practitioner or physician™s assistant, they got the electronic medical record open and that computer version of their healthcare has a lot of data in it. And we would hope that that data is accurate but not always is it. And so my first request would be look at that data, go over it with your provider; look at your past medical history. Is the data that™s in there is it accurate? Does it talk about your illnesses? Is there something that™s omitted? Or is there something on there that got put in in error and you really don™t have that illness? Your medication list, is that medication list up to date? Does it have all of your prescription medications at the right dose with the right instructions? What about your herbal medications and the alternative medications? Are those all on there? Because there can be interactions between those medications and what™s prescribed. So I think it™s important that you go over that with your doctor. And then the procedures that you™ve had, are they up to date? Are they appropriately placed in the medical records so it™s accurate? And your immunizations, is your immunization list, is up to date? Does it list of all of those immunizations that you™ve had to date so that we can help make suggestions on which ones you™re going to need in the future? And I need my patients™ help to keep that information up to date and they need to be actively reviewing it.

Scott Gilbert: The information™s in there but if it™s not accurate, if it™s not up to date, it™s of no use to you as a provider.

Dr. Bill Curry: Or could provide an error in the thought process for caring for a patient either in my office, in the emergency room, or in the hospital.

Scott Gilbert: As we prefer to draw this conversation to a close, I want to encourage you to, if you don™t already, please do follow Milton S. Hershey Medical Center on Facebook. And that will allow you to get notifications about future conversations, future episodes of Ask Us Anything About And of course, as I mentioned earlier, when the show ends we will continue to address any additional questions that you have. All you have to do is enter them in the comment field and we can have those responded to offline here as well. We have a question from online about how to prepare the population to be good consumers of health. Alright. Can you talk a little bit about that topic? You know what does it mean to prepare the population to be good consumers of health in your mind?

Dr. Bill Curry: So I think to have a relationship with somebody that you can call them your primary care provider. It can be an internist. It can be a family physician. As an adolescent, it could be a pediatrician.

Scott Gilbert: Right.

Dr. Bill Curry: It can be a nurse practitioner or a physician assistant. But somebody that has an overall view of who you are and where you™re going in terms of your care through the medical journey so that they can be making comments both to you and to those of the team that are caring for you. I think that™s really important. I think to prepare for every visit that you™re going to have at the office, making sure that you know your medications and you know the dose, and that you bring them with you, I think is really important. And then I think that when you™re getting ready for that visit you know if you™ve got questions, if you™ve got concerns, write them down, make a list. And perhaps we won™t have time at that visit to handle all those questions but you™ve got them documented, we can look at the list and decide if there™s any that absolutely have to be done today. But we can look at that list and then work through it and if we need to schedule additional time, we can do that. But I think to make that list ahead of time is really important. I think to get to know how to use the electronic record so that you can communicate directly with your provider and your provider™s office is really important. We™re going to move more and more to this and we do it in all of our practices here at the Hershey to be able to communicate directly with providers. So we get messages on a daily basis. We can attend to those messages. We can make suggestions or we can suggest that you know this is something that we really need to see you for.

Scott Gilbert: Sounds good. There was a question about checklists. You say, Is there a checklist¦

Dr. Bill Curry: Checklist available for consumers to come in to know what the¦

Off-Camera Voice: And the other question was Is there a way to, how, what kind of recommendation do you have to find a new primary care physician? What should look for?

Scott Gilbert: OK, so say if somebody™s looking for a new primary care physician, [inaudible] and that can be tough especially if someone moves to a new area, doesn™t even know really where to start, what are those things to look for?

Dr. Bill Curry: So my first recommendation is to work with an office where the providers are board certified or board eligible, so they have taken their boards in medicine or pediatrics or family medicine or their eligible to sit for their boards and waiting to take those tests, so I think that™s really important. As a provider, that™s boarded, we have to recertify. We have to have ongoing education on a yearly basis, so a board certified physician is going to be mandated to stay up to date, so we think that™s really important. After that, it™s really up to the patient. Do you want your office to be close to your work? Do you want your office to be close to your home? And I take care of patients that live far away but work close and I have patients that live close and work far away, so that™s you know personal preference. And then I think you™ve got to understand the style of the provider that you™re working with. And we all have different temperaments and we all have different styles and they all can work, and you just have to be able to be comfortable with that personality and style of the provider, and those would be my suggestions.

Scott Gilbert: Makes good sense. Dr. Bill Curry, thank you for your time today.

Dr. Bill Curry: My pleasure, thank you very much.

Scott Gilbert: Dr. Bill Curry is a family medicine physician here at Penn State Health Milton S. Hersey Medical Center. You may recognize his name if you read last week™s Penn State Medical Minute, which can be found on our website pennstatehealthnews.org, and you can read that. Again, as I mentioned earlier, we hope that you will follow us on Facebook so we can tell you about future episodes of Ask Us Anything About, these Facebook live discussions. Thank you for your questions if you™ve been watching us live and you™re one of the folks who provided a question. If you™re watching this in playback form on Facebook, perhaps at a later time or date, feel free to add your questions to the comment field. It™s not too late to get an answer. We™ll make sure that question finds its way to Dr. Curry and that we put an answer online for you. Again, we will continue to address any of those questions online and we hope that you will join us for the next Ask Us Anything About episode on the Facebook page of Penn State Health Milton S. Hershey Medical Center. Have a great day!