• Shenary J. Cotter, MD

Screening: looking for something wrong when nothing is wrong

The most common reason that people come to the physician is that something is wrong. Often, it is due to symptoms that have either not responded to normal over-the-counter medications and "tincture of time," or it is due to the patient being concerned that it is more serious than the troublesome but largely benign viral illness or rash.

One of the most IMPORTANT reasons to establish with, and come in to see, your physician is for health screening. A screening test or evaluation is something that is done to look for a problem when there are no symptoms or signs of the problem. An example would be a screening mammogram, or a colonoscopy for someone who has reached the age of 50. The goal of these tests is to either catch a disease early, and thus decrease the harm it may cause (such as cancer), or to prevent disease altogether (such as with checking lipid panels to prevent heart disease).

Over the years, physicians have come up with many different hopeful screening tests, but some have not stood the test of time. Others have been adapted as data on their effectiveness has made it more clear. Recommendations change depending on new evidence. An example of the latter is the PAP smear, which screens for cervical cancer. Previously done yearly, it is now done with or without high-risk HPV screening at either 3 year or 5 year intervals.

An excellent source for what screening tests are indicated is the United States Preventive Services Task Force. Their recommendations take into account the quality of evidence that supports the screening test.

In our direct primary care practice, we have found an increased effectiveness in using the screening recommendations for our patients because we have time to get an excellent family and personal history. We also have time to explain the data behind the screening recommendations. This allows for what is called "shared decision-making" discussions that are meaningful. In shared decision - making discussions, we are interested in finding out what the patient cares about, and not just recommending things according to guidelines.

If you would like to find out more about how we are better able to provide screening testing that complies with guidelines AND with shared decision-making discussions, please call to set up your free meet-n-greet with one of our physicians. The number is (352)204-0120.

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