Screening guidelines should not replace doctor/patient relationship
The recent revision of the recommendations for women receiving mammograms by the U.S. Preventive Services Task Force has created a lot of controversy, according to two Texas AgriLife Extension Service specialists.
While guidelines for preventive testing and screening measures are certainly important, they cannot and should not replace a long-term, trusted relationship with a primary care provider as an aid in decision-making, say Andrew Crocker, AgriLife Extension program specialist for gerontology and health, and Dr. Carol Rice, AgriLife Extension professor and health specialist in College Station.
"Guidelines come, go and change--your health provider's knowledge of your family health history and your current health status is best able to recommend preventive screening measures," said Crocker.
"Everyone is different, and thank goodness for that," he said. "As such, one-size-fits-all medical recommendations may not be right for you given your particular family health history, health status, environmental conditions, etc."
Groups such as Preventative Services Task Force conduct impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications, Crocker said.
The task force's recommendations are considered the "gold standard" for clinical preventive services; however, individual needs and health status may vary, he said.
The recommendations that come from such groups do not represent official policy on any level, said Rice. Certainly, these recommendations may result in some policy changes sometime in the future, but that is yet to be seen--recommendations may also be ignored.
Many groups within the health care establishment are against the new recommendations for mammography, she said. Until the issue is resolved, plan for check-ups and mammograms as scheduled and talk to a health provider about any concerns. Further, those at high risk for breast cancer or who suspect they might be should make that known when calling for an appointment.
"It is important to remember that having a primary provider is one of the best ways to ensure your good health," Crocker said. "This doctor knows you and what your health normally is like. He or she can help you make medical decisions that suit your values and daily habits and can keep in touch with other medical specialists and health care providers you may need."
Finding a primary care provider may be a difficult task, he said. Priorities are finding a doctor with whom the patient feels comfortable talking to and who accepts the available insurance.
"If you don't have a primary doctor or are not at ease with the one you currently see, now may be the time to find a new doctor," Crocker said.
Identify criteria that are important to you before making a choice, he suggested. Get the names of several doctors and then consult reference sources, including friends and family, plus do a little research on the doctors before making a choice.
"Your health provider, whether new or existing, should know about your illnesses or operations, medical conditions that run in your family and other doctors you see," Crocker said. "You may want to ask for and fill out a copy of the medical history form before your visit so you have all the time and information you need to complete it."
A family health history is a record of illnesses and medical conditions affecting family members, he said. Similar to a family tree, a family health history includes information for each person about diseases, causes of death and other health information.
Crocker said while a family health history cannot predict future health, it may provide information about risk. A health care provider may use the information to:
--Assess risk of certain diseases.
--Recommend changes in diet or other lifestyle habits that can lower disease risk.
--Determine diagnostic tests to order and recommend treatments.
--Determine the type and frequency of screening tests.
--Determine whether an individual or family members should get a specific test.
A family health history should include at least three generations, he said. Compile information about grandparents, parents, uncles and aunts, siblings, cousins, children, nieces and nephews and grandchildren.
Gather as much accurate information as possible, Crocker said. Include information about race and ethnicity because the risk of a particular disorder may be greater in one group than in others. Ask about the occurrence of diseases and medical conditions often associated with genetics.
The health care provider and patient should review the document together and clarify any questions, he said. The family health history should be updated every couple of years and given to the health care provider.
The Surgeon General has created a computerized tool to help make it fun and easy to create, Crocker siad. My Family Health Portrait provides a template in both English and Spanish for inputting information and generating a family health history.
My Family Health Portrait helps users organize information and then print it for their health provider. In addition, the tool helps users save their information to their own computer and even share with other family members. This free tool may be accessed at http://familyhistory.hhs.gov.
"Clear communication between you and your health providers is essential to quality health care," Crocker said. "Health providers train for a very long time learning the science of medicine, but they cannot learn from a book the individual nature of your personal health status.
"It is important for you and your health provider to understand what is going on in your body so that you achieve or maintain your best overall health," he said.