Annual wellness visit
Well-woman care focuses on an annual office visit throughout the lifespan. The patient and doctor reconnect, a thorough update of the history is obtained, and, through discussion and shared decision-making, a plan is made for the physical exam that day and for any recommended preventive and screening services, labs, or imaging, if any, based on a woman’s age, risk factors, and personal choices.
Preventive care
The field of medicine is sometimes reasonably criticized for emphasizing too much the treatment of disorders rather than their prevention in the first place. The best medical practices do both. There is no more valuable undertaking than the prevention of disease. Fortunately, modern medical research has made strides at developing evidence for the most effective methods of prevention.
There are four major categories of preventive care:
- Immunizations – such as vaccines for HPV, the flu, and shingles
- Screening – such as pap smears, mammograms, sexually transmitted infection screening, and physical exams
- Behavioral counseling – such as diets and safe sex practices
- Chemoprevention – drugs if indicated, such as statins to reduce elevated cholesterol levels or antihypertensives to reduce high blood pressure, both of which can reduce the risks of heart disease, stroke, or kidney disease
The value of preventive care is determined by considering how serious and how likely is the condition being prevented, balanced against the costs, risks, and effectiveness of the intervention. In general, it’s the job of the doctor to provide the best up-to-date information in a shared decision-making process where the patient is the ultimate “decider” on which course to take.
Mammogram Guidelines
An example of shared decision-making is the deliberation regarding at what age and how frequently a woman should have a screening mammogram. Getting them more frequently (annually vs. biennially) reduces the odds of developing a fatal breast cancer, but at the cost of having more false positives – abnormal results that do not turn out to be cancer but cause worry and may prompt further evaluation (possibly including biopsy) to be safe.
In other words, more frequent mammograms, tend to save some lives due to early cancer detection, but significantly more women will undergo the physical and emotional trauma from the extra scrutiny and procedures from questionable results that turn out to be benign. Each woman, appropriately informed by her doctor, must weigh the importance of each possible outcome for herself. See Breast Screening and Care for more information.
Pap smears and cervical cancer screening
Another prominent example of preventive care is using pap smears to prevent cervical cancer by screening for treatable precancerous conditions. It is important to adhere to guidelines for pap smears to prevent the risk of cervical cancer. The recommended interval varies between one and five years depending on each patient’s history, previous results, and the type of smear obtained. This is reviewed at each annual visit to be sure you remain on schedule.
Sexually transmitted infection (STI) screening
When indicated or requested, testing for sexually transmitted infections (STIs) can be part of well woman care. Knowing when to consider this requires an understanding of each woman’s situation because some STIs may have little or no initial symptoms and, thus, go untreated. They may then cause serious problems later including severe infections, infertility, and complications of pregnancy. Therefore screening (testing) for some STIs is very important for certain patients at risk.
Authoritative preventive guidelines
Respected and frequently cited sources of recommendations exist, such as the American College of Obstetricians and Gynecologist (ACOG) and United States Preventive Services Task Force (USPSTF). An important part of the physician’s job is to understand, keep up with, and share these recommendations. Sometimes guidelines may differ. For example, these two groups disagree somewhat on the recommended frequency of mammograms. This makes the doctor-patient discussion and shared decision-making even more critical.
Summary
Your annual wellness visit and plan remain the vital cornerstones to the maintenance of your best health and the prevention of disease. Formal recommendations for pelvic exams, pap smears, and breast exams for women not having symptoms or problems have recently become more relaxed (although not for patients having complaints or problems or who desire examination for reassurance). Regardless of which, if any, examination should be performed, the best course is to meet annually to discuss, plan, and decide together.
To schedule a well-woman visit, or for more information, please call 919-916-3333.
