What You Should Know About Well Woman Exams
Kim Guida, MD, discusses what women need to know about well exams. She discusses why they differ from standard physicals, what women can expect during the exam, and at what age women should start having these exams.
Featuring:
Kim Guida, MD
Kim Guida, M.D. is the Medical Director of Pullman Family Medicine, part of the Pullman Regional Hospital Clinic Network. She worked at a rural health clinic in Buhl, Idaho for several years before moving back to Washington to join Pullman Family Medicine in 2002. She is board certified in Family Medicine, is a Fellow of the American Academy of Family Physicians, and enjoys a broad spectrum of practice, with particular interests in Obstetrics, Pediatrics, and Women's Health. Transcription:
Bill Klaproth (Host): So why should you consider and what do you need to know about well woman exams? Well let’s find out with Dr. Kim Guida, medical director of Pullman Family Medicine, part of the Pullman Regional Hospital clinic network. Dr. Guida, thanks so much for your time. First off, what is a well woman examination?
Kim Guida, MD (Guest): Yes, I’d be happy to. That term refers to a general health checkup specifically focused on screening for disease or other health concerns in asymptomatic women. It includes, just to name a few things, cancer screening, immunizations, mental health screening, and reproductive counselling.
Host: So how are these different from standard physicals?
Dr. Guida: Well, Bill, there's a lot of terms that are thrown around that are used interchangeably. A standard physical refers simply to a head to toe physical exam looking for the presence or absence of disease. So I think of like military recruits where they're having exams where the focus is purely on a current state of health as it might apply to the ability to perform a job. So a well woman exam will include a physical exam, but it’s primary focus is really more on prevention of disease. So it’s going to include a comprehensive discussion about individual risks based on the woman’s personal and family history, maybe her lifestyle choices like diet, exercise, smoking and that sort of thing. Then, of course, we discuss age appropriate screening tests.
Host: Got it. So that’s really good to know. So you focus on prevention of disease during a well woman examination. Then you will do all the regular things that normally take place in a physical as well. Is that right?
Dr. Guida: Exactly, right.
Host: Okay so then what happens during a well woman exam? What kind of things do you screen for? Tell us that. How does that work?
Dr. Guida: Yeah so we follow some guidelines. The guideline that we typically use is the United States preventative services taskforce. So that has a set of recommendations for age specific screening tests that are appropriate. It’s not going to be the same for everyone. So these can be kind of lumped into some categories. For example, screening for heart disease, screening for cancer, reproductive and endocrinologic issues, infection screening and immunizations, and then mental health screening as well. So if we take a little bit of a deeper dive into those topics, an example of screening for heart disease would be checking for high blood pressure, obesity, high cholesterol, and other family history of heart disease, smoking, and that sort of thing. Often times the well woman exam is the first time that women will be diagnosed with things like hypertension or high cholesterol, which then of course we can treat. Things like cancer screening is also a common thing that we do and address at well women exams. Cancer screening, such as cervical cancer screening with a pap smear, breast cancer screening with mammograms. We’ll talk about colon cancer screening for women who are over 50, and then, of course, we do skin cancer screening just as part of the physical exam as well. Then, of course, most women think about the well woman exam as being primarily reproductive, addressing those reproductive issues, which we do as well. So we’ll address contraception. We’ll assist pregnancy planning, and then also address symptoms related to menopause such as hot flashes and addressing risks for osteoporosis or low bone density.
The other category I was going to mention is the infection and immunization. So, of course, in younger women we’re going to be screening for certain infections like sexually transmitted infections, HIV, hepatitis C, and also providing immunizations that are age appropriate such as tetanus shots, pneumonia shots, shingles, flu, that kind of thing. So finally the thing that’s often forgotten and is support important is screening for mental health issues like depression, anxiety, substance use, and then also domestic violence or partner abuse is really important to address at those exams too.
Host: That is really a comprehensive list. I could see where this would really be something that all women would want to have. So then why are well women examinations important to consider for all women?
Dr. Guida: Well, I think a lot of times people only go to the doctor when they're sick, right. They figure well I've had the visit; I've seen the doctor; everything should be fine. Those visits when they're sick are focused simply on the symptoms at hand at that time. We just don’t have time in those visits to check to see if they’ve had those preventative screening tests that we just discussed. So a lot of times patients can go many years just having these intermittent urgent care visits and then later can be diagnosed with a disease that we could have picked up earlier, even prevented in the first place, if we had an opportunity to do so.
Host: Well, those are all really important points to consider. So then at what age or stage of life should women start having well woman exams?
Dr. Guida: Well there's really no strict guidelines for how often a woman should have a prevention visit or when to start, but in general we would recommend in starting in the late teens or early 20s and then doing that about every two to three years as long as the woman is healthy with no chronic conditions that need to be followed. Then as they get older, like 40 to 50, we start recommending yearly visits just because the likelihood of disease is going to increase with age.
Host: So then are well woman exam’s done with your primary care provider or does it have to be with an OBGYN provider?
Dr. Guida: Well these visits can certainly be done by an OBGYN provider, but the thing is if there are things that are detected that are not primarily gynecologic—for example high cholesterol or high blood pressure, diabetes, that kind of thing—women are then referred on to primary care to manage those conditions. So I feel like primary care doctors are really best suited for these types of exams because we have a real broad range of training to treat these different illnesses.
Host: Right. Is there any other important information people should know about well woman exams?
Dr. Guida: Bill the only thing I would mention is that most insurance companies these days will include annual wellness exams as a benefit that is not subject to their deductible. So that’s a free opportunity for women to make sure that they're up to date on the recommended preventative health services. It’s also an opportunity to build an ongoing relationship with their primary care doctor. I think as physicians those relationships are very important because when we are given the opportunity to get to know patients when they're well we can do a much better job taking care of them when they're sick too.
Host: Well Dr. Guida, this has been really fascinating. Great information. Thank you for sharing your time today.
Dr. Guida: Well you're very welcome. It’s been a pleasure.
Host: That’s Dr. Kim Guida. To get hooked up with a provider and to learn more, just visit pullmanregional.org. That’s pullmanregional.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Health Podcast from Pullman Regional. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So why should you consider and what do you need to know about well woman exams? Well let’s find out with Dr. Kim Guida, medical director of Pullman Family Medicine, part of the Pullman Regional Hospital clinic network. Dr. Guida, thanks so much for your time. First off, what is a well woman examination?
Kim Guida, MD (Guest): Yes, I’d be happy to. That term refers to a general health checkup specifically focused on screening for disease or other health concerns in asymptomatic women. It includes, just to name a few things, cancer screening, immunizations, mental health screening, and reproductive counselling.
Host: So how are these different from standard physicals?
Dr. Guida: Well, Bill, there's a lot of terms that are thrown around that are used interchangeably. A standard physical refers simply to a head to toe physical exam looking for the presence or absence of disease. So I think of like military recruits where they're having exams where the focus is purely on a current state of health as it might apply to the ability to perform a job. So a well woman exam will include a physical exam, but it’s primary focus is really more on prevention of disease. So it’s going to include a comprehensive discussion about individual risks based on the woman’s personal and family history, maybe her lifestyle choices like diet, exercise, smoking and that sort of thing. Then, of course, we discuss age appropriate screening tests.
Host: Got it. So that’s really good to know. So you focus on prevention of disease during a well woman examination. Then you will do all the regular things that normally take place in a physical as well. Is that right?
Dr. Guida: Exactly, right.
Host: Okay so then what happens during a well woman exam? What kind of things do you screen for? Tell us that. How does that work?
Dr. Guida: Yeah so we follow some guidelines. The guideline that we typically use is the United States preventative services taskforce. So that has a set of recommendations for age specific screening tests that are appropriate. It’s not going to be the same for everyone. So these can be kind of lumped into some categories. For example, screening for heart disease, screening for cancer, reproductive and endocrinologic issues, infection screening and immunizations, and then mental health screening as well. So if we take a little bit of a deeper dive into those topics, an example of screening for heart disease would be checking for high blood pressure, obesity, high cholesterol, and other family history of heart disease, smoking, and that sort of thing. Often times the well woman exam is the first time that women will be diagnosed with things like hypertension or high cholesterol, which then of course we can treat. Things like cancer screening is also a common thing that we do and address at well women exams. Cancer screening, such as cervical cancer screening with a pap smear, breast cancer screening with mammograms. We’ll talk about colon cancer screening for women who are over 50, and then, of course, we do skin cancer screening just as part of the physical exam as well. Then, of course, most women think about the well woman exam as being primarily reproductive, addressing those reproductive issues, which we do as well. So we’ll address contraception. We’ll assist pregnancy planning, and then also address symptoms related to menopause such as hot flashes and addressing risks for osteoporosis or low bone density.
The other category I was going to mention is the infection and immunization. So, of course, in younger women we’re going to be screening for certain infections like sexually transmitted infections, HIV, hepatitis C, and also providing immunizations that are age appropriate such as tetanus shots, pneumonia shots, shingles, flu, that kind of thing. So finally the thing that’s often forgotten and is support important is screening for mental health issues like depression, anxiety, substance use, and then also domestic violence or partner abuse is really important to address at those exams too.
Host: That is really a comprehensive list. I could see where this would really be something that all women would want to have. So then why are well women examinations important to consider for all women?
Dr. Guida: Well, I think a lot of times people only go to the doctor when they're sick, right. They figure well I've had the visit; I've seen the doctor; everything should be fine. Those visits when they're sick are focused simply on the symptoms at hand at that time. We just don’t have time in those visits to check to see if they’ve had those preventative screening tests that we just discussed. So a lot of times patients can go many years just having these intermittent urgent care visits and then later can be diagnosed with a disease that we could have picked up earlier, even prevented in the first place, if we had an opportunity to do so.
Host: Well, those are all really important points to consider. So then at what age or stage of life should women start having well woman exams?
Dr. Guida: Well there's really no strict guidelines for how often a woman should have a prevention visit or when to start, but in general we would recommend in starting in the late teens or early 20s and then doing that about every two to three years as long as the woman is healthy with no chronic conditions that need to be followed. Then as they get older, like 40 to 50, we start recommending yearly visits just because the likelihood of disease is going to increase with age.
Host: So then are well woman exam’s done with your primary care provider or does it have to be with an OBGYN provider?
Dr. Guida: Well these visits can certainly be done by an OBGYN provider, but the thing is if there are things that are detected that are not primarily gynecologic—for example high cholesterol or high blood pressure, diabetes, that kind of thing—women are then referred on to primary care to manage those conditions. So I feel like primary care doctors are really best suited for these types of exams because we have a real broad range of training to treat these different illnesses.
Host: Right. Is there any other important information people should know about well woman exams?
Dr. Guida: Bill the only thing I would mention is that most insurance companies these days will include annual wellness exams as a benefit that is not subject to their deductible. So that’s a free opportunity for women to make sure that they're up to date on the recommended preventative health services. It’s also an opportunity to build an ongoing relationship with their primary care doctor. I think as physicians those relationships are very important because when we are given the opportunity to get to know patients when they're well we can do a much better job taking care of them when they're sick too.
Host: Well Dr. Guida, this has been really fascinating. Great information. Thank you for sharing your time today.
Dr. Guida: Well you're very welcome. It’s been a pleasure.
Host: That’s Dr. Kim Guida. To get hooked up with a provider and to learn more, just visit pullmanregional.org. That’s pullmanregional.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Health Podcast from Pullman Regional. I'm Bill Klaproth. Thanks for listening.