Changing the Frequency

Looking for fewer medical appointments? Here are 3 ways to streamline your visits

Heidi Godman
Harvard Health Publishing

How many days a year do you spend getting healthcare outside the home? A Harvard Medical School analysis found the average was 21 days among people ages 65 or older in traditional Medicare — mainly for office visits, tests, imaging studies like x-rays and treatments. And it was 50 or more days a year for 11% of these adults. That’s nearly one out of every five weekdays.

Committing a lot of time to healthcare visits can be challenging, especially if you have to take time off from work or if you have mobility or transportation issues.

“Clinicians should be the ones thinking about how we can make healthcare more efficient. But if they don’t, remember that you have some power in the process,” says Dr. Ishani Ganguli, an associate professor of medicine at Harvard Medical School and an internist at Harvard-affiliated Brigham and Women’s Hospital.

Ganguli recommends three strategies for reducing the number of days you devote to medical appointments.

1 Eliminate unneeded care

Some healthcare might not be necessary or effective. Examples include imaging or screening tests for people at low risk of certain conditions (such as a stress test for stable coronary artery disease) or surgery for a joint problem when physical therapy would be just as effective.

How can you jettison unneeded care? The Choosing Wisely campaign, from American Board of Internal Medicine’s ABIM Foundation, suggests asking your doctor these questions:

• Do I really need this test or procedure?
• What are the risks?
• Are there simpler, safer options?
• What happens if I don’t do anything?
• How much does it cost?

Ganguli suggests adding another question to understand if a test is really helpful: How will the results of this test change our plan?

2 Consolidate appointments

Find out if it’s possible to consolidate appointments or coordinate various doctor visits, tests or imaging for the same day.

“For example, if a patient of mine comes in because she’s having knee pain, and I notice that she’s due for routine blood work for diabetes, I get that done on her visit instead of having her come in for a second visit,” Ganguli says. “If I didn’t offer that option, it would be entirely appropriate for the patient to say, ‘I’m here for new knee pain, but I know I’m due for a diabetes check as well. Is that possible?’”

It’s also appropriate to ask your doctor about new health concerns you have, even if you’re there for something else. Make a list of your questions and concerns in advance, so you can be as efficient as possible. Then, at the start of the visit, tell your doctor that you’d like to discuss concerns about a possible new health condition, so the doctor will allow time for your questions.

“Keep in mind that if you ask about new health concerns during an annual wellness visit, the doctor is often supposed to charge an add-on fee to insurance, which may require a copay,” Ganguli says.

3 Use telemedicine

Many insurers pay for medical visits conducted via a telephone or video call. The technology can be used in place of many types of appointments that would normally happen in person, such as mental healthcare visits or routine follow-ups for diabetes or high blood pressure.

What telemedicine doesn’t always replace is the social element.

“Many people like seeing their doctor in person and prefer it,” Ganguli says. “But I have other patients who are busy and can’t or don’t want to spend time getting to and from an appointment.”

How to talk to your doctor

You might feel uncomfortable about discussing the issue of reducing your healthcare visits, but dr. Ishani Ganguli urges you to speak up for yourself.

Many people have obstacles to coming to the office or hospital, such as getting time away from work or finding transportation. don’t be hesitant to tell your doctor about such problems, and to seek ways to make fewer office visits.

As Ganguli notes, “doctors mean well, but they aren’t always aware how hard it is for people to go in for a visit. It’s within your rights to tell your doctor if it’s a problem.”

COVID may reveal link between viruses and cancer

Corinne Purtill
Los Angeles Times

LOS ANGELES — In early 2022, about the time the Omicron variant started driving a new surge in COVID-19 cases, researchers at James DeGregori’s University of Colorado Anschutz lab noticed something unusual: When lab mice with dormant breast cancer cells were infected with either influenza or SARS-CoV-2, the animals were significantly more likely to develop aggressive lung tumors.

When the team examined healthcare databases, they were surprised to find something similar appeared to be going on in the human population.

Analysis of records from the U.K. Biobank showed that cancer survivors who contracted COVID-19 in 2020 — when the virus was new and no vaccine was available — were significantly more likely to die of recurring cancer than patients who didn’t get the virus, particularly within the year after their COVID-19 infection.

Analysis of a separate U.S. breast cancer database found breast cancer patients in remission who got COVID-19 were significantly more likely to develop metastatic lung tumors than patients who did not contract the virus.

The University of Colorado researchers couldn’t analyze influenza’s effects as thoroughly — most flu infections don’t make it into medical charts, as patients often ride out routine cases at home. Researchers also weren’t able to take into account whether the severity of a patient’s COVID19 infection influenced the likelihood of a cancer recurrence.

But COVID-19’s novelty gave the team the data it needed to track the effects of viral inflammation on cancer recurrence. Their results were published last year in the journal Nature.

“We think that these virus infections can be almost like fuel for the fire,” DeGregori said.

The sheer scale of COVID19’s spread vastly deepened science’s understanding of the ways viruses can continue to affect a human body long after the initial illness passed.

Scientists need a critical mass of data to be able to identify statistically significant patterns. In the case of a pandemic “where the whole population gets infected, basically you have a denominator of 7 billion people,” said Dr. Stanley Perlman, a University of Iowa microbiologist who studies coronaviruses.

The rapid increase in patients suffering from long COVID19 supercharged research on post-viral syndromes — the complex collection of lingering symptoms doctors long observed in some patients infected with pneumonia, flu or other viruses.

Now, as more years of post-pandemic data accumulated, scientists also are able to look more closely at the complicated relationship between COVID-19 and cancer.

Still, the pandemic left some evidence that viral infection may play a role in reawakening dormant cancer cells present in a patient’s body before infection.

A sharp increase in metastatic breast cancer cases in the pandemic’s early years was largely attributed to care delayed by pandemic restrictions, rather than a real increase in incidence.

More recent work suggests “it’s not just the logistics of the pandemic, but it’s really something inherent to infection” behind the association with cancer recurrence is “something inherent to infection,” said Melanie Ott, director of the Gladstone Institute of Virology and a professor of medicine at UC San Francisco.

The effect isn’t specific to COVID-19, Ott pointed out. One of the body’s natural defense mechanisms against a virus like COVID-19 or influenza is the release of cytokines, proteins that act as chemical messengers helping to coordinate the immune system’s response. In some severe infections, the immune system can overcorrect and send out an excess amount of these proteins, a serious and potentially fatal reaction called a cytokine storm.

Research in the early months of the pandemic showed patients with severe COVID-19 who died or required hospitalization were much more likely to have runaway levels of cytokines, including a particular protein called interleukin-6, or IL-6.Chronically high IL-6 levels also were linked to recurrence and metastasis of multiple types of cancer.

Southwest Montana Health Care Directory