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Well Visits, Vaccines and Annual Screenings
Whether it be a preventative measure or for treatment, primary care doctors are an important part of fulfilling our medical needs. Dr. Arif Hussain discusses the importance of well visits, vaccines, and annual screenings with a primary care doctor.
Featuring:
Arif Hussain, MD
Arif Hussain, MD is an Internal Medicine Physician with St. Francis Medical Associates. Transcription:
Joey Wahler (Host): Whether it be a preventative measure or treatment, in sickness or in good health, primary care doctors are an important part of fulfilling our medical needs. So we're discussing the importance of well visits, vaccines, and annual screenings with a primary care physician.
This is St. Francis Medical Center's Word On Wellness, a podcast brought to you by St. Francis Medical Center. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Arif Hussain, an internist with St. Francis Medical Associates. Dr. Hussain, thanks for joining us.
Dr Arif Hussain: Hello. How are you?
Joey Wahler (Host): Good. Thanks. So first, we'll go into some further details in a moment, but to start, simply put, why is it important for someone to have a primary care physician?
Dr Arif Hussain: Well, I think it comes down to if you equate it to the world of sports, you need a field general pretty much. Somebody that can be in charge of coordinating care, making sure that we're not missing anything that might be ignored because somebody hasn't seen the doctor in a couple of years.
Joey Wahler (Host): I love the sports analogy by the way, doc. Excellent.
Dr Arif Hussain: I'm a big sports fan, so...
Joey Wahler (Host): As am I. We're going to get along just splendidly. So let's start with this then, as far as some specifics are concerned, what's the purpose of so-called well visits, regular checkups, even when your health is relatively good?
Dr Arif Hussain: It comes down to making sure that you remain healthy because there might be something that we find on a physical exam or it comes up on blood work that we order for the person that maybe at this time has not shown itself with symptoms, so the person is not aware of it. Also, that's where like a family history is important to know and to be aware of because there might be things that we have to look for, depending on a person's family history as well.
Joey Wahler (Host): And so a primary care doctor becomes familiar with you and your history as you've alluded to. And therefore, they may notice, you may notice, something important, even if it's a subtle health change that another doctor may not, right?
Dr Arif Hussain: Yes, because unfortunately, and nobody is to blame for this, a lot of specialists, based on training and what kind of time they have, they only tend to focus a lot of times on their particular field. So it's up to us in the primary care field to go over the whole body, really from head to toe and make sure that any changes that maybe even the patient themselves didn't notice we keep track of.
Joey Wahler (Host): And so primary care doctors really, along with serving many other roles, of course, you're really a jack-of-all-trades.
Dr Arif Hussain: That's what I say a lot to my patients as well, that we're a jack-of-all-trades, but a master of none a lot of times, because we have to know treatment options, medications, various differential diagnoses about pretty much anything that could happen to a person.
Joey Wahler (Host): So primary care doctors are obviously kept informed by specialists of a patient's medical tests or treatment elsewhere. And then, that enables you if you're seeing them on a regular basis to offer your input or maybe a referral, right?
Dr Arif Hussain: So ideally, other specialists should send us a fax or an electronic record of what they talked to the patient about, what their findings were. And accordingly, we make notifications in the patient's chart and then be aware of looking out for it at their next visit. And then, if it is something that needs to be pursued further, we can send them referrals for other specialists that might diagnose and treat it better than we can.
Joey Wahler (Host): Would you say from your experience that a patient is more likely to share or discuss a certain health issue with you as their primary, especially something that may be private or perhaps a little embarrassing because they have a history and a comfort level with you?
Dr Arif Hussain: I have seen over the years, definitely. You develop a rapport and a relationship with whole families sometimes, and they come to you with things that they might not feel comfortable with people they see only when they need to. And it helps because I always tell people that you know your body better than anybody else does. So if there is something emotionally, physically, that's bothering you, please don't be afraid to bring it up at the visit.
Joey Wahler (Host): What are some of the things off the top of your head that can pop up that are dangerous, perhaps even serious, maybe even life-threatening if someone goes many years without going to the doctor, particularly a primary care physician, because you do see people like that, right, for whatever reason?
Dr Arif Hussain: Yes. I mean, new patients come and tell me that they haven't been to a doctor in like seven years, so it was time for them to come. But you don't know if you're missing uncontrolled diabetes, even if the patient is not having outright symptoms of uncontrolled diabetes. Or there are skin changes that maybe the person was ignoring for any number of reasons that you find that really needs to be worked up by a dermatologist. Sometimes even stuff that people consider minor, when you look further into it with an imaging test or blood work, can end up being a problem that needs to be taken care of sooner rather than later.
Joey Wahler (Host): And speaking of blood tests and the like, primary care doctors can obviously make sure you're up to date with preventative screenings, vaccines, things of that nature. Let's talk first about blood work and preventative screenings. How often should someone have blood work through a primary care doctor and what kind of preventative screenings are important on a regular basis?
Dr Arif Hussain: Well, bloodwork really depends on age and other factors. If you're younger and I'm in internal medicine, so I don't start really seeing patients until they're 18 years old when they're considered an adult. But when you're in your late teens, early 20s with no significant other factors socially, family-wise, you could do blood work once every couple of years as long as everything is normal. But as you get older past the age of 25, it's better to do blood work once a year so that we don't miss anything, that may pop up in between. And obviously, as you get older and you develop medical issues or something significant happens in the family, first-degree relatives are considered more important obviously than more distant relatives, then we may have to do blood work even more often than once a year, maybe every three months, every six months, depending on what the abnormalities are.
Part of going to primary care, your family physician, is also preventative measures. And there's a lot of preventative measures that are out there that timeframe depends on what we're looking for. Say for diabetes, if you have a family history, you honestly should do blood work once a year for the sugar and there's a blood test called the hemoglobin A1c that should be checked in order to rule in or rule out diabetes.
Cholesterol, when you're younger, again, I said, no family history, then every five years is fine. Once it starts becoming abnormal, I honestly think it's better to do it once a year. Cancer screening is also considered. We're the ones who get started with the cancer screening. So breast cancer, for a normal person that does not have a family history, it's recommended to start at 40 for women. Colon cancer, for a normal average person, the guidelines have recently been lowered to the age of 45 for colonoscopies or other tests that exist for colon cancer screening. Now, according to the US Preventative Services Task Force, we should start ruling out lung cancer for people that fit the criteria for lung cancers, smokers starting at the age of 55, if they actively smoke or have recently quit within the last five to ten years.
Then, you know, there's more specific screenings for women with the Pap smears that depends on how old they are, if they're sexually active or not. But I mean, everybody is under consensus that at 21, whether you're sexually active or not, should be your first Pap smear and frequency will be determined as to what abnormalities are seen on the Pap smear. Those are some of the basics of preventative screenings and blood work.
Joey Wahler (Host): And then how about vaccines? We hear so much about them naturally during the pandemic. But, COVID aside, how about vaccines that may be needed along the way?
Dr Arif Hussain: Most people, by the time I get to see them have already received their childhood vaccines. Adult vaccines, I mean, everybody knows whether they believe to get it or not, the annual flu vaccine. And then also, commercials have informed a lot of people about stuff, but now we see a lot of commercials about pneumonia vaccines and shingles vaccines.
Pneumonia vaccine really, like a lot of things in medicine, depends on other medical problems. So for a young, healthy person, you really don't need to get a pneumonia vaccine until the age of 65, honestly. That's an older vaccine with no significant issues that would compromise you and puts you at more risk of getting pneumonia. And there's two vaccines for that a year apart. But if you have a condition such as diabetes or another immunocompromised state, asthma, COPD, then you need to start getting pneumonia vaccines in your 50s.
And then shingles, most people have had chicken pox when they were younger. And thus, because it's a viral illness, it kind of sticks around in your body even as you get older. It just remains dormant until you get some kind of a significant insult to your body, physical or emotional. And as an adult, chicken pox can present as shingles. So there's no like actual definite age guideline, but there are certain organizations that say 50 and over for a shingles vaccine. Some people say 60 and over for the shingles vaccine. And again, there's a newer shingles vaccine that was, I think, initiated about five, six years ago that is now also a two-part vaccine where you get one and about three, four months later, you get a second vaccine.
And then, you know, there is also a tetanus vaccine that most of us got when we were younger. As an adult, it's recommended to repeat that every 10 years. And then one time, to substitute a normal tetanus vaccine with what's called a TDAP vaccine where we also protect people against the whooping cough, that's recommended for one time after the age of 50 in place of the normal tetanus vaccine. And then 10 years later, you can resume the regular tetanus vaccine.
Those are like the three or four major vaccines aside, like you said, from the COVID vaccines that we'll come across. Depending on also where people travel to different parts of the world, you need more specific vaccines, like yellow fever, hepatitis, these kinds of vaccines are more with particular situations.
Joey Wahler (Host): And then finally, doctor, and perhaps most importantly, considering the way our conversation started, you mentioned you're a huge sports fan. What's your favorite sport or team?
Dr Arif Hussain: So I was pretty much born and raised in the New York City area. So baseball, I'm a diehard New York Yankees fan. Basketball, unfortunately, I'm a diehard New York Knicks fan. I don't know when I'm able to see a championship there. I'm not a big hockey guy, but I do follow the Rangers from time to time. Football, the only sport where I went outside of the New York area. I'm actually a Denver Broncos fan.
Joey Wahler (Host): Okay. Interesting. Well, as a fellow Knicks fan, I'm sure we could spend a lot of time talking about whether, as you alluded to, we'll ever see a championship again during our lifetime, right?
Dr Arif Hussain: It's a story for another podcast.
Joey Wahler (Host): Absolutely. That's another podcast. We'll put that on the schedule for another day. Dr. Arif Hussain, very valuable information about seeing a doctor, a primary care physician on a regular basis. Again, thanks so much for joining us.
Dr Arif Hussain: My pleasure. You're welcome.
Joey Wahler (Host): And folks, for more information about St. Francis Medical Associates or to make an appointment with one of their medical providers, please call 855-599-SFMC. That's 855-599-7362 or visit stfrancismedical.org. That's stfrancismedical.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to St. Francis Medical Center's Word On wellness, a podcast brought to you by St. Francis Medical Center. Hoping your health is good health, I am Joey Wahler.
Joey Wahler (Host): Whether it be a preventative measure or treatment, in sickness or in good health, primary care doctors are an important part of fulfilling our medical needs. So we're discussing the importance of well visits, vaccines, and annual screenings with a primary care physician.
This is St. Francis Medical Center's Word On Wellness, a podcast brought to you by St. Francis Medical Center. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Arif Hussain, an internist with St. Francis Medical Associates. Dr. Hussain, thanks for joining us.
Dr Arif Hussain: Hello. How are you?
Joey Wahler (Host): Good. Thanks. So first, we'll go into some further details in a moment, but to start, simply put, why is it important for someone to have a primary care physician?
Dr Arif Hussain: Well, I think it comes down to if you equate it to the world of sports, you need a field general pretty much. Somebody that can be in charge of coordinating care, making sure that we're not missing anything that might be ignored because somebody hasn't seen the doctor in a couple of years.
Joey Wahler (Host): I love the sports analogy by the way, doc. Excellent.
Dr Arif Hussain: I'm a big sports fan, so...
Joey Wahler (Host): As am I. We're going to get along just splendidly. So let's start with this then, as far as some specifics are concerned, what's the purpose of so-called well visits, regular checkups, even when your health is relatively good?
Dr Arif Hussain: It comes down to making sure that you remain healthy because there might be something that we find on a physical exam or it comes up on blood work that we order for the person that maybe at this time has not shown itself with symptoms, so the person is not aware of it. Also, that's where like a family history is important to know and to be aware of because there might be things that we have to look for, depending on a person's family history as well.
Joey Wahler (Host): And so a primary care doctor becomes familiar with you and your history as you've alluded to. And therefore, they may notice, you may notice, something important, even if it's a subtle health change that another doctor may not, right?
Dr Arif Hussain: Yes, because unfortunately, and nobody is to blame for this, a lot of specialists, based on training and what kind of time they have, they only tend to focus a lot of times on their particular field. So it's up to us in the primary care field to go over the whole body, really from head to toe and make sure that any changes that maybe even the patient themselves didn't notice we keep track of.
Joey Wahler (Host): And so primary care doctors really, along with serving many other roles, of course, you're really a jack-of-all-trades.
Dr Arif Hussain: That's what I say a lot to my patients as well, that we're a jack-of-all-trades, but a master of none a lot of times, because we have to know treatment options, medications, various differential diagnoses about pretty much anything that could happen to a person.
Joey Wahler (Host): So primary care doctors are obviously kept informed by specialists of a patient's medical tests or treatment elsewhere. And then, that enables you if you're seeing them on a regular basis to offer your input or maybe a referral, right?
Dr Arif Hussain: So ideally, other specialists should send us a fax or an electronic record of what they talked to the patient about, what their findings were. And accordingly, we make notifications in the patient's chart and then be aware of looking out for it at their next visit. And then, if it is something that needs to be pursued further, we can send them referrals for other specialists that might diagnose and treat it better than we can.
Joey Wahler (Host): Would you say from your experience that a patient is more likely to share or discuss a certain health issue with you as their primary, especially something that may be private or perhaps a little embarrassing because they have a history and a comfort level with you?
Dr Arif Hussain: I have seen over the years, definitely. You develop a rapport and a relationship with whole families sometimes, and they come to you with things that they might not feel comfortable with people they see only when they need to. And it helps because I always tell people that you know your body better than anybody else does. So if there is something emotionally, physically, that's bothering you, please don't be afraid to bring it up at the visit.
Joey Wahler (Host): What are some of the things off the top of your head that can pop up that are dangerous, perhaps even serious, maybe even life-threatening if someone goes many years without going to the doctor, particularly a primary care physician, because you do see people like that, right, for whatever reason?
Dr Arif Hussain: Yes. I mean, new patients come and tell me that they haven't been to a doctor in like seven years, so it was time for them to come. But you don't know if you're missing uncontrolled diabetes, even if the patient is not having outright symptoms of uncontrolled diabetes. Or there are skin changes that maybe the person was ignoring for any number of reasons that you find that really needs to be worked up by a dermatologist. Sometimes even stuff that people consider minor, when you look further into it with an imaging test or blood work, can end up being a problem that needs to be taken care of sooner rather than later.
Joey Wahler (Host): And speaking of blood tests and the like, primary care doctors can obviously make sure you're up to date with preventative screenings, vaccines, things of that nature. Let's talk first about blood work and preventative screenings. How often should someone have blood work through a primary care doctor and what kind of preventative screenings are important on a regular basis?
Dr Arif Hussain: Well, bloodwork really depends on age and other factors. If you're younger and I'm in internal medicine, so I don't start really seeing patients until they're 18 years old when they're considered an adult. But when you're in your late teens, early 20s with no significant other factors socially, family-wise, you could do blood work once every couple of years as long as everything is normal. But as you get older past the age of 25, it's better to do blood work once a year so that we don't miss anything, that may pop up in between. And obviously, as you get older and you develop medical issues or something significant happens in the family, first-degree relatives are considered more important obviously than more distant relatives, then we may have to do blood work even more often than once a year, maybe every three months, every six months, depending on what the abnormalities are.
Part of going to primary care, your family physician, is also preventative measures. And there's a lot of preventative measures that are out there that timeframe depends on what we're looking for. Say for diabetes, if you have a family history, you honestly should do blood work once a year for the sugar and there's a blood test called the hemoglobin A1c that should be checked in order to rule in or rule out diabetes.
Cholesterol, when you're younger, again, I said, no family history, then every five years is fine. Once it starts becoming abnormal, I honestly think it's better to do it once a year. Cancer screening is also considered. We're the ones who get started with the cancer screening. So breast cancer, for a normal person that does not have a family history, it's recommended to start at 40 for women. Colon cancer, for a normal average person, the guidelines have recently been lowered to the age of 45 for colonoscopies or other tests that exist for colon cancer screening. Now, according to the US Preventative Services Task Force, we should start ruling out lung cancer for people that fit the criteria for lung cancers, smokers starting at the age of 55, if they actively smoke or have recently quit within the last five to ten years.
Then, you know, there's more specific screenings for women with the Pap smears that depends on how old they are, if they're sexually active or not. But I mean, everybody is under consensus that at 21, whether you're sexually active or not, should be your first Pap smear and frequency will be determined as to what abnormalities are seen on the Pap smear. Those are some of the basics of preventative screenings and blood work.
Joey Wahler (Host): And then how about vaccines? We hear so much about them naturally during the pandemic. But, COVID aside, how about vaccines that may be needed along the way?
Dr Arif Hussain: Most people, by the time I get to see them have already received their childhood vaccines. Adult vaccines, I mean, everybody knows whether they believe to get it or not, the annual flu vaccine. And then also, commercials have informed a lot of people about stuff, but now we see a lot of commercials about pneumonia vaccines and shingles vaccines.
Pneumonia vaccine really, like a lot of things in medicine, depends on other medical problems. So for a young, healthy person, you really don't need to get a pneumonia vaccine until the age of 65, honestly. That's an older vaccine with no significant issues that would compromise you and puts you at more risk of getting pneumonia. And there's two vaccines for that a year apart. But if you have a condition such as diabetes or another immunocompromised state, asthma, COPD, then you need to start getting pneumonia vaccines in your 50s.
And then shingles, most people have had chicken pox when they were younger. And thus, because it's a viral illness, it kind of sticks around in your body even as you get older. It just remains dormant until you get some kind of a significant insult to your body, physical or emotional. And as an adult, chicken pox can present as shingles. So there's no like actual definite age guideline, but there are certain organizations that say 50 and over for a shingles vaccine. Some people say 60 and over for the shingles vaccine. And again, there's a newer shingles vaccine that was, I think, initiated about five, six years ago that is now also a two-part vaccine where you get one and about three, four months later, you get a second vaccine.
And then, you know, there is also a tetanus vaccine that most of us got when we were younger. As an adult, it's recommended to repeat that every 10 years. And then one time, to substitute a normal tetanus vaccine with what's called a TDAP vaccine where we also protect people against the whooping cough, that's recommended for one time after the age of 50 in place of the normal tetanus vaccine. And then 10 years later, you can resume the regular tetanus vaccine.
Those are like the three or four major vaccines aside, like you said, from the COVID vaccines that we'll come across. Depending on also where people travel to different parts of the world, you need more specific vaccines, like yellow fever, hepatitis, these kinds of vaccines are more with particular situations.
Joey Wahler (Host): And then finally, doctor, and perhaps most importantly, considering the way our conversation started, you mentioned you're a huge sports fan. What's your favorite sport or team?
Dr Arif Hussain: So I was pretty much born and raised in the New York City area. So baseball, I'm a diehard New York Yankees fan. Basketball, unfortunately, I'm a diehard New York Knicks fan. I don't know when I'm able to see a championship there. I'm not a big hockey guy, but I do follow the Rangers from time to time. Football, the only sport where I went outside of the New York area. I'm actually a Denver Broncos fan.
Joey Wahler (Host): Okay. Interesting. Well, as a fellow Knicks fan, I'm sure we could spend a lot of time talking about whether, as you alluded to, we'll ever see a championship again during our lifetime, right?
Dr Arif Hussain: It's a story for another podcast.
Joey Wahler (Host): Absolutely. That's another podcast. We'll put that on the schedule for another day. Dr. Arif Hussain, very valuable information about seeing a doctor, a primary care physician on a regular basis. Again, thanks so much for joining us.
Dr Arif Hussain: My pleasure. You're welcome.
Joey Wahler (Host): And folks, for more information about St. Francis Medical Associates or to make an appointment with one of their medical providers, please call 855-599-SFMC. That's 855-599-7362 or visit stfrancismedical.org. That's stfrancismedical.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to St. Francis Medical Center's Word On wellness, a podcast brought to you by St. Francis Medical Center. Hoping your health is good health, I am Joey Wahler.