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Published: September, 2014; Vol 11, Num 4

 

A Primary Care Provider Is Essential to Your Health

“Routine medical care is constantly evolving. Having a relationship with a primary care provider has never been more important,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni.

For example, there is now dissension within the medical profession about how often two standard medical screenings and procedures – prostate cancer screening for men and pelvic exams for women – should be administered.

LIUNA General
Secretary-Treasurer
and LHSFNA Labor
Co-Chairman
Armand E. Sabitoni

“This lack of consensus can lead to confusion about what is essential health care for you,” says Sabitoni. “A primary care provider who is familiar with your health history, your habits and your family background can help you make informed decisions about whether and how often you should have these and other treatments. Your primary care provider can also recommend a specialist if one is necessary. This creates a continuity of care that is helpful in ensuring your needs are met.”

Prostate Cancer Screening

Prostate cancer is the second leading cause of death in American men. Only lung cancer claims more victims. About one out of every seven men will be diagnosed with prostate cancer. The disease will kill about one man in every 36.

For years, the prostate-specific antigen (PSA) blood test was a staple of health care and was recommended for all men once they reached age 40.

However, the PSA has a high degree of false positives as it does not directly detect cancer, but rather a protein made by the prostate. Since other conditions not related to cancer can also raise this protein level, the PSA result must be confirmed with painful biopsies and other tests. Over the years, this has led many men with little risk of dying from prostate cancer to undergo surgery, radiation and chemotherapy, and to suffer debilitating side effects, including bladder and bowel function damage and sexual difficulties.

Meanwhile, the average age of diagnosis for prostate cancer is 67, the disease is slow-growing and most men who are diagnosed can live out their lives without symptoms. Based on these findings, the U.S. Preventive Services Task Force concluded in 2012 that most men should not be routinely screened.

However, when there is a family history of prostate cancer or if you are African American – the disease occurs more frequently and at an earlier age in this group – the PSA test may still be something to consider. A frank discussion with a primary care provider who is familiar with your circumstances is critical when making that decision.

Pelvic Exams

The annual pelvic exam, beginning no later than age 18, has long been a basic of women’s health care. It was considered to be a tool for spotting certain types of cancers, infections and internal abnormalities, including ovarian cysts or uterine fibroids, and was usually coupled with Pap testing for cervical cancer. Today, however, annual Pap tests are not always recommended and the medical community is divided over how often most women should have pelvic exams.

In June, the American College of Physicians (ACP) issued a guideline advising against the annual examination for “asymptomatic, average risk, non-pregnant” women.

“[The pelvic exam] rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost,” said Dr. Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee.

However, the American College of Obstetricians and Gynecologists (ACOG) continues to promote the annual exam.

“While not evidence-based, the use of pelvic exams is supported by the clinical experiences of gynecologists treating their patients. Pelvic examinations also allow gynecologists to explain a patient’s anatomy, reassure her of normalcy, and answer her specific questions, thus establishing open communication between patient and physician,” the ACOG said.

“This difference of opinion within the medical profession underscores the importance of having a primary care provider with whom you can begin the discussion about how or if these new guidelines affect your routine medical care,” says Sabitoni. “Changes are a constant in medicine. Your primary care provider can help you navigate them and stay healthy.”

[Janet Lubman Rathner]