When the most devastating health care crisis in generations hit, Coloradans responded by steering clear of the doctor. That might sound ironic, but shortly after COVID-19 first appeared in the Centennial State, Governor Jared Polis signed executive orders that, from March 23 to April 26, 2020, prohibited providers from performing many routine medical services. Some doctors who would have been allowed to treat patients during that time voluntarily closed to preserve personal protective equipment for essential workers. And even after all medical offices were allowed to reopen, many patients demurred on seeking treatment out of fear of contracting COVID-19 while, say, getting their teeth cleaned. The aggregate result of these actions was that visits to health care providers along the Front Range in 2020 plummeted 25 percent compared to 2019 totals, according to a September 2021 report from the Colorado Health Institute, a Denver-based nonprofit.
As understandable as missing treatment was under those circumstances, the long-term impact of this so-called “foregone care” could be devastating. That’s because preventive visits, the easiest appointments to skip or reschedule, were the most likely to be missed. And without regular physicals, cancer screenings, and other evaluations, doctors lost many of their frontline defenses. “Preventive medicine is extremely important,” says Dr. Scott Joy, chief medical officer of HealthOne Physician Services Group in Denver. “If we detect problems before they become catastrophic, you’ve obviously saved a lot of money from emergency room costs, extensive procedures, and length of stay.”
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Not to mention saved lives: Preventive care has routinely been shown to decrease morbidity and mortality. (Recommended vaccines alone prevent more than 42,000 deaths in the United States each year.) Yet even before COVID-19, only eight percent of U.S. adults ages 35 and older received all the high-priority preventive treatment providers recommend.
Why do so many people pass on routine care? For many, such as the uninsured, it’s not so much a choice as a financial necessity. Others simply don’t know the doctors and tests—all of which change based on age, family history, and behavioral factors—they should regularly access. Read on to make sure you have all the information and tools you need to keep the most important New Year’s resolution of all: taking (preventive) care of yourself.
Mind the Medicine Gap
A by-the-numbers look at preventative health care in Colorado from March 15, 2020, through January 2, 2021, compared to the same period in 2019:
47%: Decrease in wellness exam visits
44%: Drop in blood-pressure exams, which help screen for cardiovascular disease
27%: Fewer HBA1C tests, which measure blood sugar and are used to check for diabetes in adults
Source: Colorado Health Institute; data based on Coloradans, from March 15, 2020, through January 2, 2021, compared to the same period in 2019
So what exactly is preventive medicine? It’s health care designed to promote wellness and stave off the three D’s: disease, disability, and death. Below, a basic outline of what that looks like—and how it changes—as you grow older. —Barbara Urzua
Babies, birth to 36 months
Whom to See (And How Often): Pediatrician (multiple times per year)
What to Expect: The American Academy of Pediatrics recommends checkups at two to four days, two weeks, and one, two, four, six, nine, 12, 15, 18, and 24 months. That may seem like a lot, but your baby’s physical growth needs to be meticulously monitored to ensure she’s eating enough and not suffering from intestinal issues. You can also anticipate hearing screenings and immunizations.
Question to Ask: Could these behaviors be a sign of autism? According to the Centers for Disease Control and Prevention, some causes of concern include avoiding eye contact, using few or no hand gestures by 12 months, and a lack of empathy by 24 months.
Children, ages 3 to 12
Whom to See (And How Often): Pediatrician or family physician (yearly); Dentist (every six months to a year); Optometrist (every two years)
What to Expect: Ensuring your child is growing and developing as he should be continues to be the most important issue during well-child visits.
Question to Ask: Which kinds of snacks are healthiest? You don’t need to hire a nutritionist to find out; it’s your pediatrician’s job to recommend alternatives to sugar bombs (looking at you, Fruit By The Foot).
Teens and young adults, ages 13 to 20
Whom to See (And How Often): Primary care provider (yearly); Dentist (yearly); Optometrist (yearly)
What to Expect: If your child is sexually active, a yearly screening for sexually transmitted infections is a must. “Teens can be hesitant to talk to their providers about these issues, but it is so crucial that they do,” says Dr. Corey Lyon, family physician and associate professor at the University of Colorado School of Medicine. This may necessitate letting your teenagers enter the exam room by themselves so they can have some privacy with the doc.
Question to Ask: What are signs of drug and alcohol abuse? If you’ve seen your kids’ grades plummet or friend groups suddenly change, these may be signs of substance abuse. The doctor or school counselor should have ideas on how to talk to them about it and, if needed, seek treatment.
Adults, ages 21 to 64
Whom to See (And How Often): Primary care provider (yearly); Dentist (yearly); Optometrist (every one to two years)
What to Expect: Age-appropriate blood test screenings are crucial to catch maladies that haven’t presented symptoms yet.
Question to Ask: How can I keep my cholesterol levels in check? If reducing saturated fats and exercising regularly aren’t working, prescription medication might.
Late adulthood, ages 65 and older
Whom to See (And How Often): Primary care provider (yearly); Dentist (yearly); Optometrist (every one to two years)
What to Expect: An often-overlooked issue among older adults is mental health, ranging from difficulty making decisions to plain isolation (which can affect mental acuity). “The pandemic has brought loneliness and inactivity for many older adults,” says Samantha Farro, geriatric psychologist at the CU Anschutz Multidisciplinary Center on Aging, “which is why mental health awareness is so important right now.”
Question to Ask: Should I think about moving to an assisted living facility? If you’re struggling with daily activities like bathing, cleaning, cooking, or even socializing, your physician is an unbiased resource for some hard truths—and they’ll have informed recommendations for appropriate living situations.
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With Colonoscopies, Everything’s Looking Up!*
Colorado Public Radio host Ryan Warner recently took to social media to document his colon cancer screening. His reason for going public? It’s personal.
*The author would like to thank Twitter user @neonnurse for inspiring this headline.
In 2000, Katie Couric famously got a colonoscopy live on the Today Show after her husband died from colon cancer. So I guess you could say I rode her coattails (or is it entrails?) by posting a photo of my procedure to Twitter in August 2021. Anyway, 12 years ago, I nearly lost my mother to the disease.
She’d been exhausted and, we later learned, was on the verge of cardiac arrest when the doctor ordered a colonoscopy. She was bleeding internally, which is common with colon cancer. In her words, she “basically had no blood left.” The latest recommendation from the Centers for Disease Control and Prevention is regular colonoscopies for men and women starting at the age of 45. My mom was 64 and had never been screened.
Mom endured multiple surgeries and started chemo, but it made her so sick that she stopped. My fears for her future metastasized, but the cancer did not: She’s been free of it for more than a decade. And today, I am free from any hesitation around prevention. At 43, I’ve already had three colonoscopies that have blessedly detected no cancer. They have, however, revealed diverticulitis with a splash of colitis, or what a friend calls my “fussy Jewish tummy.” Both are relatively manageable.
Ryan Warner is the senior host of Colorado Matters, the flagship daily show from CPR News.
Colorado’s new plan to get everyone to the doctor.
For some Coloradans, the journey to the physician’s office is easy. They schedule an appointment, drive to the building, and, thanks to their health insurance plan, hand over a copay that doesn’t destroy their budget. Others face more complications. They might have to take an unpaid day off work, work around the bus schedule, and cover the full bill.
According to nonpartisan research organization the Colorado Health Institute, 82 percent of Coloradans went to a doctor in 2021, but only 67 percent went to a preventive care appointment. Of those who didn’t, 20 percent blamed cost and 10.5 percent said they couldn’t get time off work. Insurance access represented the biggest decider: Of all uninsured Coloradans, about 43 percent said they’d foregone care. Communities of color, whose members face lower rates of insurance than white Coloradans, were slightly more likely to say they’d skipped a doctor’s appointment because their lack of insurance made the visit too expensive.
Signed into law in June 2021, the Standardized Health Benefit Plan Colorado Option aims to erase cost as a hurdle by requiring insurance companies operating in the state to create insurance plans with premium rates that, by 2025, will be 15 percent lower than their cheapest plans in 2021. The plans, which will become available in 2023, are designed for residents who don’t have insurance through their employers but earn too much to qualify for Medicaid. Moreover, the law mandates that each insurer’s physician network include providers who are working to reduce racial health disparities, such as doctors who employ translators in their offices for Spanish-speaking patients. “It could potentially provide better outcomes for these communities who have faced historical health barriers,” Healthier Colorado spokesperson Kyle Piccola says.
Even after the Colorado option launches, providers need to do a better job of considering patients’ entire lives when treating communities of color, says Dr. Cleveland Piggott, the vice chair for diversity, health equity, and inclusion for the Department of Family Medicine at the University of Colorado Anschutz Medical Campus, where he is also a professor. CU’s A.F. Williams Family Medicine Clinic in the Central Park neighborhood began screening patients in 2017 for social factors such as job loss or food insecurity as well as other things that can impact health, such as race or chronic conditions.
During the pandemic, CU nursing students used that information to proactively contact at-risk patients—people with diabetes, for example—to nudge them to attend preventive appointments. “We want patients to come to us,” Piggott says, “but to make sure our communities are healthy, we need to go to them.” —Angela Ufheil
Yes, doctors have to poke and prod—i.e., run tests—to make sure your body is healthy. At the same time the U.S. health care system spends $300 million annually on unnecessary medical exams, according to the Choose Wisely Campaign, an American Board of Internal Medicine Foundation initiative focused on removing superfluous treatments from primary care visits. So which tests are necessary, and which aren’t? Fortunately, a federally funded panel of experts called the U.S. Preventive Services Task Force (USPSTF) waded through the research and assigned letter grades to various medical screenings. Here, a curated selection of preventive health exams that made the USPSTF’s honor roll—and some that failed. —Spencer Campbell
The Benefit Is Substantial
- Women ages 21 to 29 should get screened for cervical cancer every three years, but a Pap test alone is enough for this age group. Women 30 to 65 require a Pap test every three years or can opt for high-risk human papillomavirus testing every five years (doing both is OK, too).
- Every adult ages 50 to 75 needs to undergo screenings for colon cancer. This ranges from yearly fecal occult blood testing to a colonoscopy every 10 years. (If you are especially concerned about colon cancer, the USPSTF gives a B to the 40 to 49 demographic receiving these same screenings.)
The Benefit Is Moderate to Substantial
- To detect any indication of amblyopia (when one eye is weaker than the other; it’s often referred to as a “lazy eye”), kids ages three to five years old should have their vision screened at least once.
- At least once between the ages of 18 and 79, adults should be screened for the hepatitis C virus, even if they don’t show any signs of liver disease.
- The USPSTF advises that all women 50 to 74 years old get a mammogram every two years. All women with histories of breast, ovarian, tubal, or peritoneal cancer in their families should conduct a familial risk assessment and potentially receive genetic counseling for the BRCA gene mutation.
The Net Benefit Is Small
- A test that looks for prostate-specific antigen proteins in the blood could indicate prostate cancer in men ages 55 to 69—but could also result in false positives that lead to “overtreatment,” which can have deleterious complications such as erectile dysfunction.
- While men ages 65 to 75 who have ever smoked should be screened for abdominal aortic aneurysms at least once (the USPSTF rates this a B), men who have never smoked see very little benefit from the sonogram test.
No Net Benefit or the Harm Outweighs the Benefit
- If women have no history and don’t show any symptoms of ovarian cancer, there is absolutely no need to be screened for the disease.
- Even among smokers, it’s not necessary to test for chronic obstructive pulmonary diseases, such as emphysema, unless the patient displays signs of the malady.
Controlling The Uncontrollable
Dr. Savita Ginde on her personal journey from mammogram to mastectomy.
The majority of women diagnosed with breast cancer are women without a history, which is what I am. No one in my family has had the disease. Well, in March 2021, I went in for a routine mammogram. It came back abnormal—there was a suspicious lesion.
At that point, we didn’t know if it was cancer. It was just an area of concern. I had no lumps or bumps. After going back for more images, a biopsy, and an MRI, I decided to get a lumpectomy, and that’s when it was upgraded from an area of concern to a carlobular carcinoma in situ. Then there are these algorithms they put you through that weigh factors, such as when you started your menstrual cycle, so everything really becomes very specific. For most women, the risk of breast cancer across their lifetimes is one in eight. Mine was somewhere between 50 percent and almost 70 percent.
I talked it through with my team—a medical oncologist, breast cancer surgeon, and reconstructive surgeon—and we landed in the same place. This past September, I underwent a double mastectomy. It wasn’t an easy procedure, but this is why you get preventive care, right? It definitely gave me and my family information to at least feel like we had some control over my destiny.
Dr. Savita Ginde is the chief health care officer at Wheat Ridge–based Stride Community Health Center, which provides primary care services to underserved communities.
The Power of Positive Thinking
A Denver psychiatrist takes us inside the health of a happy brain.
Most people only notice their mental health when it turns blue. Preventive care, however, is just as important for the routine wellness of our minds as it is for our bodies, says Dr. Carl Clark, a psychiatrist and the CEO of the Mental Health Center of Denver, which treats about 21,000 patients a year. To that end, about a decade ago the nonprofit began teaching the PERMA method to Colorado businesses seeking to brighten their workplace cultures. The construct, developed by University of Pennsylvania professor Martin Seligman, helps people leverage positive psychology (the scientific study of what makes life most worth living) to feel happy and fulfilled. Clark outlines how to make PERMA’s tenets a part of your day-to-day routine—in and out of the office. —SC
“Positive emotions are highly subjective; I have friends who jump out of airplanes, and they like it. But some of the things you can do are more universal than others. Gratitude, for example, is a positive emotion. It could be as simple as writing down five things every day that you’re grateful for.”
“Engagement is that thing where time disappears. Some people call it a state of flow; you’re so into what you’re doing that nothing else—not email, not bills, not other stressors—even exists. I used to be a big whitewater kayaker, and I can tell you when I was whitewater kayaking, I wasn’t thinking about work. I was focused on surviving.”
“Objectively, you can actually look at your relationships with people and—thanks to online assessments you can use—see how positive or negative they are. Even in a professional setting, if a worker is highly effective at their job, they might be so toxic that company performance improves when they are dismissed.”
“People find meaning in all kinds of ways. We’ve all heard the story about the bricklayers: One says, I’m laying bricks. One says, I’m building a wall. The last says, I’m building a cathedral for the future. It doesn’t matter what you do. You just need to know that what you’re doing has purpose.”
“One of the great gifts we have is our ability to thank other people. One of the exercises we have people do is to write a letter to somebody important in their lives, thanking them, and to read it in person. The positive effect on the writer’s well-being lasts for six months.”
The Doctor Will Text You Now
The anatomy of local advances in health care technology.
At least one health care interaction hasn’t declined during the pandemic. In fact, telemedicine visits on the Front Range increased from fewer than 100 per week before March 2020 to more than 30,000 by July 2020, according to data compiled by the Colorado Health Institute. Many physicians, Denver-based Dr. Scott Joy says, believe virtual preventive care appointments will continue to increase in popularity due simply to their convenience. Soon, however, we won’t need to wait to see a doctor—virtually or in person—to be alerted that our health is in danger. The latest preventive medicine technology impacts us as we go about our everyday lives, vigilantly monitoring and treating our bodies from head to toe. —SC
Kaiser Permanente Colorado is sending select cardiovascular disease patients home with Bluetooth-enabled scales that monitor for changes in weight that could correspond with fluid overload in the heart—a symptom of congestive heart failure—and automatically send the results to the doctor.
In 2020, UCHealth’s Virtual Health Center, which had focused on monitoring patients inside the hospital, began remotely tracking the well-being of COVID-19 patients once they were discharged. A device attaches to a person’s finger and connects wirelessly to an app, giving UCHealth providers up-to-date data about their oxygen levels, heart rates, and respiratory rates.
At the beginning of the pandemic, Joy relied on more at-home exams, including a colon-cancer screening product called Cologuard. The Wisconsin-based company uses a patient’s mail-in stool sample to check for the traces of blood and DNA left by precancerous polyps.
High blood pressure when pregnant can be an indication of preeclampsia, which can result in damage to the mother’s organs and, since it restricts the flow of blood, lower birth weights. Kaiser’s remote-monitoring blood-pressure cuffs alert providers if an expectant mom might be at risk of the complication.
Kaiser’s remote glucose monitoring system allows patients with diabetes to prick their fingers at home and upload the results to their medical records using their smartphones. “We can check and say, Are you taking your medications? Did you decide to take less? Are you drinking soda?” says Dr. Ari Melmed, the medical director for telehealth at Kaiser. “Or did you just decide to have a big bowl of pasta?”