Ask Dr. Hallberg: Making the most of wellness visits

Last week's discussion about wellness visits prompted some questions about how things actually work in medical clinics, especially given the economic realities of high deductible plans and clinic economics.

Dr. Jon Hallberg is back to follow up on how to make the most of wellness visits. Hallberg is MPR News' regular medical analyst on All Things Considered with Tom Crann. He is a physician in family medicine at the University of Minnesota.

An edited transcript of the conversation follows.

TOM CRANN: Let's say you go to your doctor for just one specific complaint, and let's say it's back pain. How much general attention is it realistic to expect, beyond that complaint?

DR. JON HALLBERG:It really depends. I think that we're all trained to certainly take the blinders off, look at the big picture. Back pain, in your case, you know often if they're in pain; a person is going to have elevated blood pressure. That kind of goes hand in hand perhaps. If normally their blood pressure is fine, well great, but if it's consistently high, then that may lead to another conversation. It's really rare, I think, in medicine that a person comes in with just one specific thing and we don't, on some level, touch on other things that are going on.

CRANN: You said last week, though, it's also really rare that somebody comes in just for the wellness check. "I have no complaints, Dr., just check me out." But given that plans have that high deductibles these days and is affordable care actually going to cover that visit, are people trying to cram in as much as possible and call that a wellness visit?

HALLBERG: Absolutely. This has been happening for quite some time, but I think we're seeing a lot more of it now, and people have a $5,000 deductible, but they get one preventative visit a year. Of course they're going to take advantage of that, and who can blame a person for doing that.

CRANN: You said last week, studies show these wellness visits don't make that much of a difference. But what are some of the basic things that do make a difference that probably will be determined at almost any visit?

HALLBERG: First, you're going to start with the vital signs, plus. Of course you've got a person's gender and age, and that helps determine what's going to happen. Then you look at the proportionality: the height and weight calculation called a Body Mass Index. You look at one of the vital signs, for sure, which is blood pressure. Then we now consider smoking status to be a vital sign, and that's a huge determinate of people's health. And then two tests, typically a lipid or cholesterol panel for certain age groups and a glucose. Knowing those basic things, which frankly can happen at a wellness screening even at a place of business or employment, can tell us a lot and that's a good place to start.

CRANN: It sounds like some of those stats don't have to happen in the clinic, right? You could have a blood pressure cuff at home.

HALLBERG: Absolutely. In fact, we're really encouraging that and I think what's happening more and more now is that people are coming to me for their wellness visit. They had this sort biometric screening where they look at these five things in the office setting, and now it's kind of my job to help interpret what they mean because sometimes the numbers really do require a little deeper dive than what appears at first blush.

CRANN: You and I were talking before about an article that says there are three tests that are pretty serious and could save your life. They shouldn't be avoided. What are they?

HALLBERG: There are three tests that could save your life, and we're really talking about cancer screening in this case. The three are cervical cancer screening for women between the ages 21 and 65, colon cancer screening for men and women 50 to 75, and breast cancer screening for women 50 to 74. Despite all of the controversies we've heard about all of that, these tests, pretty conclusively save lives.

CRANN: Finally, Jon, any rules of thumb for how long that list of complaints you need to bring into your doctor for a visit should actually be?

HALLBERG: Sure. Well, I think that it depends on where you seek your care. Some systems have 10-minute visits and 20-minute visits. I know that in my clinic we have 20 and 40, so those are the short and long appointments. If you're in a clinic system and they're seeing 20, 30, 40 people a day, you probably already know that you're not going to have the opportunity to ask a laundry list of questions. But even at the university, when we we've got maybe more complex people, my admonition is for people to be respectful of how many questions they've got and knowing that time is limited. We just can't get to everything at every visit.

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