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Preventive care: from self-care to lab tests.

Preventive care: from self-care to lab tests Everybody knows that an ounce of prevention is worth a pound of cure. But why is that precious "ounce" so seldom covered by medical insurance? Further complicating the issue, some standard preventive or early-detection tests that used to be routine, such as chest X-rays and complete blood counts, are no longer generally recommended. Many people are unsure what a medical checkup consist of--and how often they need one. The annual or biannual "complete physical," ounce regarded as a necessity, has now been discarded, since it proved to be too expensive for patients and insurers alike. Furthermore, it didn't pay off in terms of better health and longer life. Over the long run, the head-to-toe physical exam for symptomless people doesn't play a decisive role in keeping them healthy.

Yet there are certain tests, such as mammography, blood pressure checks, and blood cholesterol measurement, that are essential. These can detect disease at an early stage, when there's still time to cure it or take measures to keep it from progressing. Besides this, immunizations are available against many infectious diseases; these ought to be given to everyone at risk. What should your doctor be doing for you? How regularly should you be screened? Should you get a checkup every so often, even though you're feeling fine? Should healthy, symptomless adults be routinely tested for glaucoma? Diabetes? Should they be examined for cancer?

Advice from the Task Force

Several years ago, at the request of the government, a committee of physicians known as the U.S. Preventive Services Task Force reviewed all available evidence about preventing illness and concluded that it's pointless for all people to have the same batery of tests routinely, regardless of their age, sex, or symptoms. For example, if you have no symptoms of diabetes and no risk factors (such as obesity or family history of the disease), there's no point in your being screened for the disease. Similarly, for most people there's no point in having a routine chest X-ray. People should receive preventive services and seek screenings based on their personal risk factors and symptoms. The Task Force conclusions about what makes sense are summarized in the chart at right. Please note that recommendations on the chart do not apply to pregnant women, infants, and children, who need ongoing surveillance by a physician or other health professional.

Health care without doctors, checkups, or tests

Besides the tests listed on the chart, there are other important preventive measures, the kind of commonsense prevention that could save millions of medical dollars and prevent injury, illness, and premature mortality. This kind of preventive self-care will be familiar to readers of this newsletter:

* Avoiding tobacco and illegal drugs.

* Keeping alcohol consumption moderate (no more than two drinks daily, one drink being defined as five ounces of wine, 12 ounces of beer, or 1.5 ounces of spirits, which all contain about the same amount of alcohol).

* Preventing sexually transmitted diseases and unintended pregnancy.

* Getting regular exercise.

* Eating a diet low in fat and rich in fruits, grains, and vegetables.

* Fastening seat belts, and driving sober and defensively.

* Brushing and flossing to prevent dental disease, and getting regular dental checkups.

* Keeping the home environment safe.

Not one of these measures is expensive, and the only ones that require professional services are contraception and the dental checkup.

The U.S. Preventive Services Task Force strongly recommends that doctors talk with patients about all these issues, though it recognizes that doctors often lack the time--or simply don't take the time--to explain the basics of a healthy diet, for example, or to urge patients to stop smoking or change their sedentary habits. As a rule, doctors don't get paid for counseling.

According to the Task Force report, if prevention is to work, people must assume greater responsibility for their own health. The physician's most important job is to treat illnesses and injuries, while the patient's most important job is to take every possible step to keep them from occurring. This requires an activist attitude on the part of the patient--and close cooperation with the doctor.
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Title Annotation:includes information on insurance coverage
Publication:The University of California, Berkeley Wellness Letter
Date:May 1, 1991
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