Preventive Care

Happy Monday, and welcome to the first installment of my new ongoing series, Medical Mondays!

I figured it’d probably be most fitting to start off by talking about preventative care, and how important that is. In my last couple months of rotations, there have been so many patients who don’t take care of themselves, skip their follow-up appointments and/or wait until they’re in very dire circumstances to finally go and see a doctor. When asked why they don’t take their medications or check their sugars or blood pressure, a lot of them answer that it’s “because they didn’t feel bad, so they didn’t feel that they needed it.”

I’m currently on my Internal Medicine rotation, and I’ve deduced that my preceptor is pretty much superhuman. Aside from having an M.D. and being a pulmonologist back when he was India, he also happens to have an MBA and a law degree (boarded in California), owns two private practices, and also sees patients at my base site’s hospital. He says the local hospitals aren’t too fond of him because he offers almost everything they do (x-rays, sleep studies, ultrasounds, labs, echocardiograms, PET scans, nerve conduction studies, etc.) at about 1/5th to 1/10th the cost. He’s magical.

He also practices what he preaches, and eats even healthier than I do. Not that I eat super-healthy all the time, but he’s the first preceptor I’ve had thus far who does this! Top that with a hilariously dry sense of humor + sarcasm, and you can probably see why I think he’s all sorts of awesome. (I hope he thinks I’m at least somewhat-awesome too, because I’d love to get a letter of recommendation from him. ;_; )

This is the analogy he uses when patients tell him they feel like they don’t need to do something because they don’t feel bad.

Dr. G: Do you have a car?
P: Yes.
Dr. G: Do you take it to get its oil changed after a certain number of miles?
P: Yeah, of course!
Dr. G: Why do you do that? The car still runs, doesn’t it?
P: Well, yes, but changing the oil helps to keep it running longer so I don’t have to pay as much later on to fix it.

The basic purpose of preventative care is to find things that might put a patient at a higher risk for certain conditions and diseases. Some risk factors are things you can’t change (e.g. age, gender, family history), but others are definitely factors that you can work with (e.g. diet, exercise).

Preventative care is way, wayyy more efficient and effective than damage control and visits to the ER.

Cardiovascular Risk Assessment

• Major risk factors include an unhealthy diet, smoking, hypertension, dyslipidemia, obesity, a sedentary lifestyle, and diabetes mellitus
• One commonly used tool to measure your 10-year cardiovascular disease (CVD) risk is the Framingham risk score, which can be determined with this calculator.

Hypertension

• A fancy way of saying high blood pressure
• Blood pressure screenings are recommended for adults who are 18 and over (they should be doing this at your annual physical anyway as part of your vitals!)
• Recommendations will vary depending on the person’s age and other risk factors

Diabetes Mellitus

• A couple risk factors include a family history of diabetes mellitus in a first-degree relative (parents or siblings), physical inactivity, or gestational diabetes (diabetes while pregnant)
• For patients who have high blood pressure or high cholesterol, it’s suggested that they are screened every 3 years for type II diabetes
• “Opportunistic screening” suggested for patients with a BMI > 25 and 1 or more additional risk factors

Hyperlipidemia

• A fancy way of saying high fat in the blood, which usually translates to high cholesterol
• This can be screened for with a blood test (usually done fasting [when you haven’t eaten yet])

Obesity

• Typically screened for with the Body Mass Index, which is calculated using your weight and height (BMI = (Weight/2.205) / (Height/39.37)²)
• BMI Calculator

• (Please note that if you have a lot of lean body mass (LBM) / happen to be a bodybuilder, etc., the BMI calculator will likely think that you are obese. You’ll be better off with a body composition analysis by way of a hydrostatic weighing tank, Bod Pod, or even skinfold calipers/bio-impedance devices.)

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations.The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)