Issue Date: January 6, 2002
What's your excuse?
I've heard my share of reasons for not getting a regular annual checkup. So who's avoiding that medical trip? These "doctorless" types of people.
ALTHOUGH AN ongoing relationship with a physician is one of the most powerful tools for ensuring good health, millions of Americans find reasons not to make that annual trip.
It seems to me that, although specific reasons differ from person to person, certain excuses recur. If you don't like to see the doctor, perhaps you'll see yourself here:
The Gambler lives with reckless abandon. Risk taking is the norm, seat belts are for sissies, and having a regular checkup is off the radar. In psychology terms, Gamblers are in a "pre-contemplation phase," meaning they have no intention of making any change soon, and, until an important health issue befalls them or someone close to them, I won't see them in my office.
The Martyr understands the need for checkups but never gets around to it, because she's so busy taking care of others. She also finds it difficult to take care of herself by exercising, preparing nutritious meals or taking time out to see a movie. Please understand, I'm not talking about people who have genuinely full schedules, but rather those who elevate "woe is me" to an attention-getting art form.
The Economist gets advice on preventive medicine at the corporate health fair, where it is free. Although it's true that "high-tech" medicine has driven up health care costs greatly over the past generation, annual preventive medicine checkups can be relatively inexpensive. I believe (and my colleagues would agree) that the most important aspect of the care I provide is the time I spend with patients. This "low-tech" medicine is extremely important. It gives me the chance to gather health information from patients, develop a relationship with them and give them guidance on potential health risks. Unfortunately, the Economist doesn't see this as financially worthwhile, despite spending thousands of dollars each year on things far more trivial than health. Remember, you get what you pay for.
The Shaman has a little information -- and it's a dangerous thing. I often run into the Shaman at social functions, such as my kids' sporting events, where I'm pulled into a conversation about treating high blood pressure with saltwater enemas, or some such thing. The Shaman is a true believer in the latest science as it is presented on the Internet or in supermarket tabloids. Shamans feel no need to follow up with a physician, because they believe they have access to boundless amounts of information.
The Informer has an ax to grind with medicine. At social engagements I hear everything wrong with my profession, including waiting time in the ER, cold-hearted nurses, medications that are too expensive -- all topics I can't readily fix while eating pizza with my kids at Chuck E. Cheese's. But Informers usually have had specific bad experiences, so I give them a chance to vent and I try to smooth feathers ruffled by a member of my profession. I love what I do, and I try to reassure Informers that there are plenty of good doctors who want only the best for them.
The Cleopatra, Queen of Denial, doesn't want to know something could be wrong. Cleos think a doctor eventually will scream at them, "You can't handle the truth!" (à la Jack Nicholson in A Few Good Men) and they'll melt down. So, they never make the first visit.
The Busy Bee works more than 50 hours a week, travels, shops, raises children, attends social gatherings and does everything but see the doctor and take care of her health. A Busy Bee's work, personal life and social life take precedence over health. If these people don't make time for health now, to paraphrase Lester Breslow, professor emeritus at UCLA, they most certainly will have to make time for illness later.
Bottom line? There are no good reasons to avoid your annual visit to the doctor. As this new year begins, make an appointment for a checkup and start building a relationship with a doctor.
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You can help make your checkup effective
Be detailed about your health history and habits.
Work with your doctor to share decision-making.
Set priorities for preventive checkups, which vary according to age, sex and personal history.
Discuss with your doctor the most likely causes of disease and disability for you, based on your history.
Source: Guide to Clinical Preventive Services; Report of the U.S. Preventive Service Task Force (Second Edition).
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