Scott Webb (Host): When choosing a primary care physician or even a nurse practitioner, it's important to remember that these folks can and will be your healthcare partners in your journey of life, not just people who treat you when you're sick. And joining me today is Dr. David Weldon. He's a board-certified internal medicine physician with Health First.

This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to basically talk about and emphasize that it's important for folks to put their health first. And we're going to try to explain to them, you know, what that means, how to view their primary care physicians as healthcare partners and all that good stuff. And it does seem to me, doctor, that the younger generation, younger than you and I anyway, often seems to only, you know, get care, receive care when they're sick, and then they go to urgent care or through virtual platforms. And sort of the old school way, if you will, of having a primary care physician and going and seeing them in the office seems like a little bit of a lost art. And we just want to try to explain to folks here today the value of having a PCP, at what point they should establish a PCP and really why is it important to their overall health.

Dr. David Weldon: Well, that is a great question, because a lot of young people very rarely go to the doctor. It's not unusual for me to see somebody in their 20s, and I'll ask them," When did you last go to the doctor?" And they will say, "I think maybe when I was 10." And, you know, it's nice to be healthy. But one of the advantages of having a primary care doctor or nurse practitioner that you see is if you do get sick, you don't have to go to one of those walk-in clinics. You can go to somebody who knows you. And most PCPs will work a patient in who's ill within a day or two. I try to see anybody who calls and says they're not feeling well. If their complaint is serious, I will try to see them that day. And a lot of PCPs operate that way. And if you do establish with a PCP, they can you know, get your medical history, and so they know a lot about you. And generally speaking, you can get better quality care. So, there's a lot of advantages to having a doctor who knows you, basically.

Host: Yeah, I think that's so right and that's definitely been my experience with my PCP. Now, I assume that when she knows that I'm coming in, as well with her other patients, that she, you know, kind of reviews information that she has, my marital status, how many kids I have, and so forth, or maybe she just has a really amazing memory and maybe you do too. But it feels like when I go to see her, that she remembers me, that she's happy to see me, that, you know, she has some sense of my medical history at her fingertips, and that makes me feel good. And for me anyway, that's why I like having a PCP, I've been going to her for 15 years plus, and I'm sure those are all part of the advantages, right?

Dr. David Weldon: Oh, absolutely. And in particular, if anything has happened to you in the past, appendicitis, a hospitalization, a car accident, they can follow up on those things because sometimes you may have a complaint or a problem, and it's related to something that is in your medical history. So, they know you, they remember you. And for me and a lot of my patients, I remember a lot of things medically that have happened to them. And you'd be surprised sometimes the new complaint is related to some injury or illness that they had previously.

Host: And I'm sure it's an advantage for both of you. And I know that, obviously, familiarity is important. Trust is important. And just kind of wondering, let's assume that folks have a PCP, how often should they actually see them? Is it once a year? Besides obviously when they're sick, that kind of thing. But what's your recommendation? How often to see their primary care physician? Does it depend on health and age?

Dr. David Weldon: If you research this, you'll see varying opinions. And the most common one you hear is a checkup once a year. And a lot of the insurance companies will pay for that. I have a slightly different approach in that. If you're under the age of 40, and you're healthy, and you're on no medications, you don't have to come in every year. Now, you should get a checkup once you leave the pediatrician's office and establish with a family practitioner or an internist. You should get a checkup with a blood panel at some point in your early 20s. And if all the blood work is good, then you don't have to keep coming in every year. I would say every two or three years for a checkup and maybe lab work. But that changes as you get older. But it really changes if there's something wrong, like if you develop high blood pressure or a thyroid condition or elevated cholesterol, then you need to be seen on a more regular basis, sometimes just once a year, sometimes twice a year, sometimes more often.

Host: Yeah. So, health, age, change in things, change in your medical status, if you will. Of course, as you say, if you have high cholesterol, high blood pressure, those types of things, and you mentioned the blood panel there. How often should folks be getting that full blood panel?

Dr. David Weldon: Well, here again, that varies. If you have diabetes, you should have it, if it's well controlled, minimally every six months. If you are on cholesterol medications, minimally once a year. If you're on thyroid medications, either every six months or once a year. If you're on no medications, and you don't have any of those conditions, if you're over the age of particularly 50, I recommend once a year. If you're under the age of 50, it sort of depends on a host of variables, one of the biggest ones of which is your weight and what the previous blood panel showed.

And I'll cite for you a typical example. You'll see somebody who's a little overweight and their blood sugar is slightly elevated. Well, that person definitely needs to come back and get blood work in a year, even if they're in their 20s. And that's because they may be developing what we call borderline diabetes, or prediabetes, or hyperglycemia. And if there's a family history of diabetes, then that's another red flag. And so, you really need to be checked once a year.

If you're 35 and all your labs are completely normal, in my opinion and in the opinion of many experts, you don't have to do blood work every year. Also, if you're not overweight and your exam is normal, you're perfectly healthy and you're 35 and all your blood work is normal, you don't need to repeat it in 12 months, in my opinion.

Host: You're making me remember fondly when I was 35 and just totally healthy. Now, that I'm in my mid-'50s, what you're saying checks out because I do have some of those things. And so, I get a full panel every year. I see my doctor every year. And fortunately, my insurance company helps out with that, which is nice. And I just want to talk a little bit about screenings, the most important screenings as we age. I'm sure that family history and genetics plays a part in that. What are, you know, the broad strokes?

Dr. David Weldon: When you talk about screening, we've already discussed screening for diabetes and that's very simple with, you know, a blood chemistry panel and you look at the blood sugar. And when you get your checkup, we actually screen you for high blood pressure and then we also ask you, "Is there high blood pressure in your family?"

For women, particularly in their reproductive years, we screen for cervical cancer and we do that with a Pap smear. And that can be done by the PCP. It can also be done by the gynecologist. Additional cancer screenings include screening for colon cancer. And that's a big and very important one. We used to recommend it beginning at age 50, now they've lowered it, recommending it at 45. However, if you have certain gastrointestinal diseases like ulcerative colitis or certain genetic abnormalities, we can recommend colon cancer screening sometimes as often as every year. And then, the other big one, of course, is breast cancer. The usual recommendation is you start doing it at age 50. And there are some experts who recommend doing it at age 40. Again, though, depending on your family history and if you come in to see me and you tell me your mother had breast cancer, your sister had breast cancer, and they both had it at an early age, I may recommend screening mammography, and genetic testing as well, beginning, you know, even sometimes before age 40. So, for the average person who doesn't have a family history, mammograms from age 50 to age 75 every year, every two years; colon cancer screening, of course, beginning on about age 45, and we quit doing that at age 80. Cervical cancer, it's another complex issue. If your Pap smears keep being normal, and you are in a stable monogamous sexual relationship, you can let the Pap smears go every two or three years. And when you hit 65, sometimes we just quit doing them if there's no abnormalities and no concerns.

So, all of these things vary, and this is a reason to have a PCP, because it's kind of complicated. Do I need a colonoscopy? Do I need a mammogram? Do I need a Pap smear? I don't know. So, you go in and you see your PCP. He looks through your chart. He might say, "No, you're not ready for screening again." And we spent a lot of our time doing that.

Host: Yeah. No, absolutely. As we kind of prefaced today, that there are just a lot of good reasons to have a PCP and to have that relationship and trust and, you know, be open and honest and all that good stuff. Just as we wrap up here, I just want to know, from your perspective, how or when do you know to refer to a specialist when we're. Dealing with a life-threatening illness like cancer. And do you go ahead and do some of the screenings beforehand, before you refer?

Dr. David Weldon: Oh, absolutely. You know, it's tragic every time I see it, but we will have, you know, a woman come in with a lump in the breast and we will send them for a mammogram and the mammogram comes back suspicious. Nowadays, we then ask the radiologist to do an ultrasound-guided biopsy and it comes back positive. And I see this once or twice a year, sometimes more often. And then, at that point, yes, you have to go see a specialist, typically a surgeon and an oncologist. Now, with the case of the colonoscopies, if we get a biopsy, and it's positive for colon cancer, often the gastroenterologist will make the referral to the surgeon. And depending on what the surgery shows, that determines whether or not the oncologist, the medical cancer doctor specialist, has to see the patient. But, yes, we refer to all kinds of specialists when it comes to managing things like cancer.

Host: Yeah. And as you say, you know, having a PCP, someone you can rely on and lean on to help sort through all of this, make sense of all of this, know when it's time to refer, which screenings to do before you refer, and, you know, all of that, your head starts to spin and that's why we have PCPs, as you said. So, good stuff today, doctor. Really educational. You are a wealth of information and you say things in a very succinct manner. You're a great guest, which I appreciate. So, thank you so much and you stay well.

Dr. David Weldon: Well, thank you.

Host: And visit hf.org/findadoc, all one word, to schedule an appointment with a PCP. And if you enjoyed this episode, please be sure to tell a friend, share on social media, and check out our entire podcast library. We look forward to you joining us again.