OHSU patients ride the tram “free”, remember
Blogging was interrupted this afternoon by going up to OHSU for a routine annual screening exam. No, I didn’t take the tram, and no, this isn’t going to be one of those too-much-information personal physical updates. It took me 25 minutes to drive from my home to Peter O. Kohler Pavilion. Looking up the trip on TriMet‘s site, it would take 76 minutes on public transportation. Interestingly, the Trip Planner gave me the bus routes, until instead of OHSU’s address I typed in “Tram Lower Station”. Then, it willingly told me the trip from home to there is 53 minutes. Add a short wait and a 4 minute ride, seems like the tram would cut about 10 minutes from my commute on transit – still more than twice the time of driving. Irrelevant anyway, since I hate heights, and wouldn’t ride the tram if you paid me. But I digress….
I thought as a public service, I would come home, do a few Google searches, and post a list of what kinds of medical screening tests we’re supposed to get, when, as we age. Well, maybe I didn’t use the right words in the search, but I couldn’t find one link to a national organization with a clear list to direct you to. And then when I did find this Palo Alto Medical Foundation site, where you can click on your age to see their recommendations, it turns out some of them aren’t necessarily supported in the rest of my research. Bottom line is perhaps best stated by the American Academy of Family Physicians, whose Screening policy states: The American Academy of Family Physicians reaffirms the principle that it is the personal physician who must assume responsibility for advising the patient as to the nature, frequency and appropriateness of screening tests. (1980) (2002)
Since the AMA no longer recommends routine annual physicals, below is some information that might help us all decide how often to seek that physician’s (or other Licensed Medical Practitioner’s) advice. Most of these are on or linked from U.S. Preventive Services Task Force on the Centers for Disease Control (CDC) web site, often with further checking on American Medical Association (AMA) pages linked from the CDC site.
Women:
Pap test: beginning screening within 3 years of the onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years, until age 65.
Hepatitis B – first visit when pregnant. Not indicated routinedly otherwise.
Annual screening mammograms and continuation of clinical breast examinations in asymptomatic women 40 years and older.
Age 45 years and older – blood test for lipid disorders
Starting at age 50: yearly stool blood test plus flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years
Age 65 and older should be screened routinely for osteoporosis, with routine screening beginning at age 60 for women at increased risk for osteoporosis.
Tetanus shot booster – every 10 years.
CDC recommends all sexually active women receive the new human papilloma virus (HPV) vaccination, reducing the risk of cervical cancer.
Men:
Age 35 years and older – blood test for lipid disorders
Starting at age 50: yearly stool blood test plus flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years
Tetanus shot booster – every 10 years.
The Task Force concluded “evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).” They found “good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes.”
This short list surprised me (and makes me worried I missed something – did I emphasize ask your doctor enough?). Even routine screening for skin cancer isn’t recommended at set intervals, nor is screening for high blood pressure, sexually transmitted diseases, dementia, hepatitis C, etc. When you do go for a physical every few years, many tests are relatively low-tech and less unpleasant than you might think – blood pressure, height/weight, one blood draw to check on things like blood sugar and liver enzymes. Not as fearsome and onerous as you might think, huh?
The issue of how to pay for preventative medical care, which is so much cheaper than costs once problems reach emergency-room status, is another post, for another time. But remember, sign up for your colonoscopy at OHSU, get the tram ride as part of the deal.