Evo Terra (Host): This is Checkup Chat with EvergreenHealth. I'm Evo Terra. And with me is Dr. Kevin Hanson, Executive Director of EvergreenHealth Emergency Medicine and Urgent Care, as we talk about the dangers of delaying care, how to stay out of the emergency room. Thanks for joining me today, Dr. Hanson.

Kevin Hanson, MD: Happy to join you.

Host: About a quarter to maybe half of all Americans say they have delayed or declined care in the last year. So at a high level, why shouldn't people delay care?

Kevin Hanson, MD: At a high level, I think the real important thing is there's things that could be either minor or are not as severe, that if you delay care become more, much more severe and much harder to treat. And I think that's one of the biggest risks of delaying care, is having a problem that's relatively straightforward become a problem that's not so straightforward and people get much more sick from that.

Host: What are the reasons you've heard why people tend to delay care? I mean, is it a factor of cost, insurance, appointments, combination of all those?

Kevin Hanson, MD: I think it's a combination. I can't say it's one thing, you know, that's 90% of the time. I can say that, you know, it's inconvenient sometimes. You know, they have work, they have life, other things happen, and it's just not the most pressing thing on their plate. Finance has certainly come into play as it's often a little opaque on what things will cost for patients Then they don't know, "Boy, can I afford to do this even with insurance? It's really expensive out of pocket." And then, just concern and worry what the answer's going to be should they go get some of that care done. Are we going to find something that's not what they want to hear? So, I think it's a combination of multiple things.

Host: When the pandemic was full-blown back in 2021, those times again, I know that a lot of people said they were delaying care during that just because of safety reasons. They had fear of going to the hospital and with other around sick people. Are we getting back to that level again with people delaying care, or is this time around it's not quite as bad?

Kevin Hanson, MD: I don't think it's quite as bad. I would say it's for different reasons now. Before, it was people were afraid to come in contact with COVID. And certainly at the beginning of the pandemic, we were seeing that all the time. Or resources just weren't available as we were shutting down elective surgeries, you know, appointments were harder to do, those sorts of things.

But I will say it's just a little different at this point. I think we're back more to the baseline of, you know, finances and inconvenience and other concerns about just their healthcare in general, would be the reasons people are delaying care at this point.

Host: Now, I know a lot of people, are delaying care as we're talking about today is don't delay care so that you don't wind up in the ER. But what sort of conditions do you see people kind of ignoring that they wind up having to be in the emergency department that could have been avoided with some timely preventative care?

Kevin Hanson, MD: Yeah. Let me give a couple examples, because I think that's probably an easier way to do this. The first would be patients who have hypertension. So, high blood pressure, something that's I wouldn't say easy to manage, but relatively easy to figure out do you have this or not with your primary care provider.

And then, subsequently, oftentimes either making, you know, lifestyle changes plus medications at times. When you don't do that, then you sort of get the side effect long-term of high blood pressure, whether that be strokes, whether that be, you know, increasing work on your heart and you have a heart attack, whether it be, you know, damage to your kidneys, those sorts of things.

And I think that's one of the easier ones to say, if we manage this well and manage it well over months to years, we see less of these side effects down the line that really, at that point, the cat's out of the bag and you need to get much more aggressive treatment that you could have taken care of earlier.

Host: What kinds of symptoms and maybe conditions should a person definitely not ignore care for?

Kevin Hanson, MD: It comes back to basic common sense on some of this to me, but I'm an ER physician, I've seen this for 25 years. But it's things like severe headache, and you normally don't have headaches. It's stroke-like symptoms. It's chest pain. And you're like, "This, I didn't fall and, you know, bump my chest on a cupboard or something like that." This is, "I'm having chest pain when I'm sitting here at rest, or I'm having chest pain when I walk around. I'm getting more short of breath. I'm feeling more weak and fatigued." Those are the kind of things you really shouldn't ignore, and you should, you know, follow up with your primary care physician or get seen if they're severe.

Host: Speaking of primary care physicians, do they have a role to play in this decision? What can they do to prevent a condition from getting so bad that someone has to go to the emergency room?

Kevin Hanson, MD: I think having a great primary care physician, which we are fortunate in our community to have hundreds of great primary care physicians, I think it's really important and having that relationship with your PCP is really key. It can help prevent, you know, the hypertension and they get you on medications earlier or talk to you about lifestyle changes. They'll monitor your cholesterol and get you on treatment for that. They'll monitor are you having signs of early diabetes and get you on medications for that if need be or lifestyle change recommendations. But having your primary care physician be sort of the quarterback of your healthcare is really important. Not everyone has a primary care physician. I would certainly encourage folks to get a primary care physician, and then see them on a regular routine basis.

Host: For those who truly can't afford care or simply say they don't have time for a medical appointment, what about some general lifestyle habits that people should do or would you recommend until they can find a time to see the doctor?

Kevin Hanson, MD: Yeah. Let me address the latter part first, time. it's become much easier, I would say even from the pandemic. A lot of, you know, negative things happened from the pandemic. We can all, you know, acknowledge that . But I will say that one thing that did get sped up through the pandemic is our ability to do telehealth visits and the ability to log in remotely. So, you're not having to take 30 minutes to drive, 30 minutes to come back to work, things like that. You can do a remote telehealth visit with your primary care physician, with an urgent care provider, very easily. So, it's much easier now. So, time, it's still important.

But that being said, some of those barriers have gone away. Answering the first part of your question around lifestyle changes, common sense things. Don't smoke. You know, minimize or moderate your alcohol use. Make sure you're getting outside and exercising. Make the fuel that you're putting in your body is good food or fuel, that it's good for your body, that you're not eating, you know, ultraprocessed fast food all the time, and that you're taking care of yourself. So, diet, food, exercise, all those things are the things that make a big difference.

Host: So as the emergency room and emergency medicine director there, can you kind of summarize for us what are the reasons why people should not delay care?

Kevin Hanson, MD: The important part, the take-home message would be is let's keep the problems as simple as we can. And if we let them progress to the point where we have to do more interventions, more medications, aggressive treatments, that's actually not great for the patient. So, we'd much rather take care of patients early in their disease, early in the process, so we can minimize negative outcomes for everybody.

Host: I think that's a fine note to end on. Dr. Hanson, thank you very much for being with me today

Kevin Hanson, MD: I appreciate your time and, hopefully, people will pay attention to this and get in early to see their primary physician and avoid those long-term, problems that we can avoid.

Host: Absolutely. Thank you, sir. And that wraps up this episode of Checkup Chat with EvergreenHealth. Head on over to evergreenhealth.com for more information and to connect with one of our providers. Please remember to subscribe, rate, and review this podcast as well as all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels. This is Checkup Chat with EvergreenHealth. Thanks for listening.