Medical experts all agree that good health depends on improved access to and increased use of preventive services. With health insurance premiums being what they are and skyrocketing even further year after year, the first part (affordable access to quality healthcare) can serve as a worthy subject for a whole book. Notwithstanding the significance of the problem, it is beyond the scope of this article. More information on getting affordable access to quality healthcare is available from http://www.megaone.com/hbb/savemoney/affordable.html
If you already have access to preventive services, you are responsible, in large part, for managing your own care. Your primary-care practitioner is your partner, but numerous decisions of paramount importance are up to you. The following should help to decide if you need any of the tests listed below. You should, if possible, have a copy of your test results and records.
These are the major screening tests (that is, routine tests for people without symptoms) and adult immunizations. The advice is based largely on the recommendations of the U.S. Preventive Services Task Force. Most HMOs and Medicare cover these services; fewer traditional insurers pay for them. Infants, children, and pregnant women need other kinds of preventive care not described here.
– Blood pressure measurement (to detect hypertension)Who needs: All adults. How often: Once every 2 years for those with normal blood pressure.Comments: More frequent monitoring for those with readings of 130/85 or higher.
– Cholesterol measurementWho needs: All adults. How often: Once every 5 years. More often if total or LDL (“bad”) cholesterol is high, HDL (“good”) is low, and/or you have risk factors.Comments: Those at high risk for heart disease need medical advice about life-style changes and possibly drug therapy.
– Diabetes screening (fasting blood glucose test)Who needs: Everyone 45 and older; earlier for those at high risk.How often: Every 3 years. Comments: Blacks, Hispanics, Asians, Native Americans, obese people, and those with a strong family history need more frequent screening, starting at age 30.
– Dental checkup Who needs: All adults. How often: Every 6 months, or on professional advice.Comments: Should include cleaning and exam for oral cancer.
– Tetanus/diphtheria booster Who needs: All adults. How often: Every 10 years. Comments: People over 50 are least likely to be adequately immunized.
– Hepatitis B vaccine Who needs: All young adults, as well as adults at high risk.How often: On professional advice. Comments: All newborns should be vaccinated.
– Chickenpox vaccine Who needs: Anyone who has never had chickenpox.How often: Once. But above age 13 it requires two shots.Comments: Not recommended for pregnant women or those with compromised immunity.
– Pap smear (for early detection of cervical cancer)Who needs: All women with a cervix, starting at age 18, or earlier if sexually active.How often: If 3 annual tests are normal, then once every 3 years. More often if you smoke, have multiple sex partners or other risk factors.Comments: Some experts advise that women who have never had an abnormal result can stop being screened after age 65.
– Breast cancer screening (mammography)Who needs: All women 50 and over; those 40-49 should discuss riskfactors with a doctor. How often: Annually. Medicare reimburses for it.Comments: Clinical breast exams are also important-consult your doctor.
– Colorectal cancer screening (fecal occult blood test, sigmoidoscopy, colonoscopy)Who needs: Everyone 50 and over; earlier for those at high risk.How often: Occult blood test annually; sigmoidoscopy every 5 years or colonoscopy every 10 years.Comments: Digital rectal exam and X-ray with barium enema may also be done. Medicare now pays for colonoscopy.
– Prostate cancer screening (prostate specific antigen, or PSA, test; and digital rectal exam, or DRE)Who needs: Blacks and men with family history, DRE and PSA starting at age 40. For others, DRE, and possibly PSA, starting at 50.How often: DRE annually; PSA on professional advice. Comments: Usefulness of PSA screening for all men remains controversial.
– Thyroid disease screening Who needs: Women 50 and over; those with high cholesterol or family history of thyroid disease.How often: On professional advice. Comments: Routine screening remains controversial. Talk to your doctor about risk factors.
– Chlamydia screening Who needs: Women 25 and younger, if sexually active. How often: Annually, or more often. Comments: Men and women of any age who are at risk for STDs (chlamydia, gonorrhea, syphilis, and HIV) should be tested.
– Glaucoma screening Who needs: People at high risk: those over 65, very nearsighted, or diabetic; blacks over 40; those with sleep apnea or family history of glaucoma.How often: On professional advice of eye specialist.Comments: Many eye specialists advise screening all adults every 3-5 years, starting at age 39.
– Influenza vaccine Who needs: Everyone 50 and over, people with lung or heart disease or cancer, and others at high risk.How often: Annually, in autumn. Comments: Even healthy younger adults can benefit and should consider getting the shot.
– Pneumococcal vaccine Who needs: Everyone 65 and over, and others at high risk for complications.How often: At least once. Comments: Effective against most strains of pneumococcal pneumonia; lasts at least 5-10 years.
– Rubella vaccine Who needs: All women of childbearing age. How often: Once. Comments: Avoid during pregnancy.
There are other important preventive measures not listed above-the kind of commonsense steps that could save millions of medical dollars and prevent injury, illness, disability, and premature death. Here’s a checklist:
– Don’t smoke, and avoid secondhand smoke.
– Maintain a healthy weight.
– Get regular exercise. Brisk walking for just half an hour every day can be a big factor in weight control and in staying healthy.
– Choose a diet low in animal fat and sodium, and rich in fruits, vegetables, whole grains, and low-fat or nonfat dairy products. Eat at least two servings of fish a week.
– Keep alcohol consumption moderate: no more than one drink daily for a woman, two drinks for a man. If you are a heavy drinker, seek counseling, and cut back or quit.
– Do self-exams of your breasts or testes, as well as skin.
– Fasten seat belts, see that kids ride in proper restraints, and obey the law. Drive sober and defensively.
– Brush and floss to prevent dental disease.
Someday there may be one magic test that will accurately detect anything and everything. Until then, this guide may be useful in making the right healthcare decision for yourself and your family.
