Michael Anderson (Host): Hello everyone, and welcome to this episode of the FortCast, the official vodcast of Fort HealthCare. I'm your host, Dr. Michael Anderson, ear, nose and throat doc, but also President and CEO of Fort HealthCare. And it is a my pleasure today to introduce to you, Dr. Allison Klimesh. Dr. Klimesh, thank you so much for being on this episode of the FortCast.

Before we get started on our topic, as we talk about preventative medicine, so much in healthcare, a big part of preventative healthcare or preventive medicine in healthcare is the wellness visit, and that's what our topic is going to be today. However, before we get to that, most of our listeners know that I've been with our organization for roughly 20 years. But Dr. Klimesh, you're relatively new to our medical staff. So, tell us a little bit about yourself.

Allison Klimesh, MD: Yeah. So, I am from Iowa in the northeast corner in a super small town of 900 people in Calmar, Iowa, but it's by Decorah. And I did my undergraduate degree at Loras College in Dubuque, Iowa. And then, I went to medical school at the University of Iowa in Iowa City. After my medical school, I went to Waco, Texas, actually, where I did my family medicine residency. And that was three years. And I enjoyed the warm winters there, but wanted to come back and be closer to family. So, I moved here this summer and have been working, doing some full spectrum care at the Jefferson Clinic.

Host: Yeah. So, your practice is solely in Jefferson.

Allison Klimesh, MD: Correct. Yep. I'm always there, Monday through Thursday.

Host: Monday through Thursday. And you also do OB.

Allison Klimesh, MD: I do do a OB, yeah. I love caring for those pregnant moms and their babies too.

Host: And I think that's important for people to realize is family medicine, there's some physicians—or a lot of physicians, I should say—within family medicine that don't do OB. But you do OB, and it was a central part of your training.

Allison Klimesh, MD: Yeah. I really loved my program in Waco. And one of the reasons I went all the way to Texas for my training was so that I could get really good OB training. So, I was pretty happy there and happy to bring that back.

Host: We're very, very happy have you. And thank you for serving our patients and community. So once somebody is born and once you deliver somebody into the world, Dr. Klimesh, one thing we start talking about are wellness visits. So, why don't we just talk about what exactly is a wellness visit and how old does somebody need to be to have a wellness visit?

Allison Klimesh, MD: So, our wellness visits start when you're like two days old, two days out of the hospital. You or your baby, I guess, at this point will have a visit to make sure that they're growing the way that they should to make sure that there's no questions about how to care for the baby. And then, the wellness visits just continue periodically throughout your life.

I think people are pretty familiar with the idea of bringing their kids in for their well-child checks, because specifically like for vaccines, that's when we would check all of the kids' vaccines and make sure they're all up-to-date. But I think there's definitely a section of people, like as you grow into your 20s, 30s, 40s, if you don't have any health problems or you don't have any concerns that it kind of falls to the wayside between all of the other expectations and things that you have to do. But really, everyone should be coming in at least yearly, even if you're feeling healthy, to make sure that all of your routine screenings are up-to-date and to check in, make sure that we have updated family histories to make sure that there's no additional screenings that you need based on some family history things that have happened as time goes on. And so, it's really a chance to make sure that even when you're feeling well, that we're optimizing your health.

Host: I think that's really, really well said. And I want to emphasize that the pediatric well-child visit is essentially what we refer to as a wellness visit. And these sort of visits are critical in order to catch something that may be happening earlier rather than later. So, it really helps us in the industry for preventive medicine.

So, Dr. Klimesh, depending on if it's pediatric or an adult visit, what are you specifically looking for? Let's do the young adult, because life gets in the way, okay? And I think young adults could certainly benefit from a wellness visit. So, what are some of the things that you're looking for when you see a younger adult for a wellness visit?

Allison Klimesh, MD: Yeah. So, I think that, really, for these visits, there's a lot that goes on in the background even before my patients even arrive at clinic. And so, I think part of the reason that the importance of them goes a little bit understated is because they can be kind of quick visits if the patient doesn't have any concerns. But before they even get there, I am looking through their charts and making sure that they don't have any medications that they're on that have effects on their kidneys or their liver that would make me want to get blood tests for that or for something else. I am looking at their age specifically and whether like male or female you have different cancer screening recommendations. And so, I'm looking to see if your cervical cancer screening is up-to-date, if your prostate cancer screening is up-to-date, if all of your immunizations are up-to-date. As you're getting into your 20s, 30s, 40s, you certainly don't need as many vaccines as a child does. But there are still some things that, depending on your risk factors like asthma or smoking, there are other vaccine recommendations that are recommended as you age too. So, checking into all of that in the background.

And then, when you come in, we get your vitals. We are looking at, you know, your weight, which gives us an idea of kind of your cardiac health sometimes. And then, it's an opportunity depending on what all your family risk factors are, your personal risk factors are. We can recommend some lab work to get an idea of anything else that could be contributing to your overall health. Because a lot of things in medicine, you don't know that they're making a difference on your body, but they're making changes over time, like high blood pressure. Most people feel totally fine if their blood pressure is high, but it does cause damage to certain organs over time. And so, we're just making sure that we know what your risk factors are and we're reducing your risk of developing serious problems in the future.

Host: And to go back a little bit earlier in the human journey, I've always been curious about the school physical or the sports physical. So, having three kids of my own that have played various sports, we always got to get that annual or every other year sports physical. Would you consider that a wellness visit as well? Because we have high demand for getting those kids in prior to their athletic participation.

Allison Klimesh, MD: Yeah, I certainly do, right? Most of these kids, they don't have any issues when they're coming in for their annual sports physicals. But I feel like for children, especially with the sports physicals, family history is a big factor. So, there are certain familial genetic conditions that can increase your risk for something terrible happening while you are exercising or exerting yourself. And we want to know what those risk factors are and make sure that that's not a risk that your kid is going to have.

Host: Absolutely. I think every parent would agree. We want to make sure that there are no undetected risks for our children as they engage in their sporting activities or their school or other school activities. Now when you're seeing anybody from two days old to prior to an adult and you're performing a well-child visit, Dr. Klimesh, what sort of things go into the well-child visit, which is another type of wellness visit?

Allison Klimesh, MD: Yeah. So for a well-child visit, I am specifically looking through your vaccination record. That's always big. And then, I'm also looking at the growth curve of the child over time. So whenever we're collecting any vital signs, that all goes into the electronic medical record, and I can actually see graph over time the child's height and weight compared to other children their age to make sure that they're gaining weight, like they should be gaining weight and growing the way that they need to be growing. That can kind of key me into any metabolic issues or genetic problems that could be affecting the child's growth. And then, I'm doing a pretty thorough physical exam, making sure that there's nothing that I am hearing different in the heart, like a murmur or any signs of asthma or breathing issues in the lungs. And then, certainly, there's some joint problems that we can find on exam as well. So, not to say that we're finding that a lot of the time, thank goodness, but it certainly happens.

Host: I tell you, children develop at a pretty rapid rate, Dr. Klimesh. So, what sort of schedule are the well-child visits on? Does it change as they are, say, much more earlier in their lifespan versus as they get a little bit older? What's the schedule like?

Allison Klimesh, MD: That's a good question. So, newborns, we see much more frequently than we need to see older children. So, there's a two-day visit, a two-month visit, and then a six-month, an eight-month rate. So as they're aging in months, we see them more often. Once they start to be about four years old, then we see them once a year and should continue to see them once a year, as long as there's no problems really for the rest of your life.

Host: Gotcha. So if we can touch base on the other end of the spectrum and talk about Medicare wellness visits, so when somebody gets onto Medicare, Medicare usually will say you need to have a wellness visit. Tell us a little bit about the Medicare wellness visit.

Allison Klimesh, MD: Yeah. So, I think Medicare wellness visits are really underutilized, honestly. And it's a great opportunity to make sure that we have all of your wishes in place within our medical record, within the hospital medical record as far as what you would want if you couldn't make decisions for yourself, as far as like a medical power of attorney. This is the visit for that kind of a conversation.

And then, additionally, my nursing team does a lot of work while they're rooming the patient within that process to make sure that each patient, each person has all of the resources that they need to live their lives fully at home or in their nursing home, wherever they happen to be. Like, making sure that they're safe as far as falls, making sure that they're connected with ears specialists, hearing specialists, eye doctors, right? Anything that we can do to help you continue to enjoy your life to its fullest as you age.

Host: Yeah. I think that the Medicare annual wellness, and it's right in the title—annual meaning once a year—is critical to help our Medicare population manage their critical conditions for years. One thing I'd like to clarify a little bit about the Medicare annual wellness visit, what sorts of specific tasks can do you do on the wellness visit versus, say, if you see a patient day to day with Medicare that come in more for a specific reason?

Allison Klimesh, MD: So, we do specific mobility testing throughout a wellness visit, like we'll ask you to sit up in a chair without using your hands. And that's a really good test for me to get an idea of what your mobility and access needs are. And then, on a typical day, like I am certainly happy to talk to somebody about what their medical power of attorney wishes would be, what their living will wishes would be, and then what their code status would be on a regular visit. But this is really a dedicated time to talk about those really, pretty heavy but very important topics so that you or your family isn't having to rush and make those decisions under pressure.

Host: Gotcha. Well, I tell you, it sounds like you could have a lot of missed opportunities to pick up on some less than desirable health conditions if you do not take advantage of the wellness visit. Would you definitely support that statement?

Allison Klimesh, MD: Yeah, I certainly agree with that.

Host: Dr. Klimesh, thank you so much. I learned a lot about the wellness visit and I'm sure our listeners have as well. And it's amazing to have you in our Jefferson community. Like you said, you're there every day, Monday through Thursday, serving the fine people at Jefferson. So, thank you for being on this episode of The FortCast.

Allison Klimesh, MD: Of course. Thank you.

Host: All right, everyone, thank you for joining us today. Please check out our website for our full library of FortCast episodes. Please share us on your social media channels. And once again, this is Dr. Michael Anderson saying thank you and have a great day.