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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
Welcome to Should I Call a Doctor? The podcast where we dive into the questions you have about your health and today's trending health topics to separate fact from fiction. I'm one of your hosts, Dr. Sam Elgawly, an internal medicine physician at Inova.
Tracey:I'm Tracey Schroeder, I lead communications for Inova. Dr. Sam will give you the clinical perspective while I ask the questions that keep patients up at night.
Sam:Today, we have with us Dr. Marc Childress. Dr. Marc Childress is a primary care physician that I've known for some time. He is board certified in family medicine and sports medicine. He joined Inova, in this capacity back in 2013 and has been practicing since 2004.
Tracey:Welcome, Dr. Childress. Thank you.
Marc:Thank you.
Tracey:It's a great time to focus on health, and many people put off their regular checkups and screenings. So that's what we want to chat with you about today. Let's talk about the importance of the annual physical and the role that that plays in building a strong foundation for your health. Tell us a little bit about that.
Marc:So it's the notion of a physical is a curious one. It kind of lies in contrast to say things that we would react to, like, I feel poorly. I have cut my hand off. I've got a complaint. A physical is a different opportunity, I think, for us to have a global perspective and kind of the way we frame it a lot in in our line of work, is it's a strategic visit. It's a forward looking visit. It is not necessarily, and granted there are times where things come up, but it's not designed to be a complaint driven visit. It's really more of a strategic visit. Looking ahead at the future, you want to have some help in terms of making strategic plans and taking a step back and looking at current inventory. What are your risks? What are your vulnerabilities? What are your opportunities? And that's really what a physical in its ideal can be. That being said, everybody's got different needs at different times.
Tracey:So keeping with the vein of that, with that strategic sense, is that what makes it important to do it annually so that you are benchmarking and then seeing what the change patterns are year over year?
Marc:I think it's become the most convenient way to do it. You know, we there's data behind a lot of this too. But for a yearly check-in, how you doing? If we go much longer than that, a lot of things can go weird. And and having some degree of continuity and connection with a provider who knows you and can appreciate and anticipate in a lot of the stuff. If we get further than that, we start to really things can fall through the cracks.
Tracey:So that's really interesting. You mentioned a provider that knows you. When you're seeing someone annually, when, you know, take it to it's a fairly healthy person . Are you really remembering them from one visit to the next?
Marc:It's a good question. And I think in in most ideal circumstances, yes. That's to your question. I'm not going to say that's ideal.
Marc:So what you want is kind of time built with somebody, and and to at least have a chance to remember somebody as opposed to, say, a 10 minute visit in an urgent care center or something like that. I have a problem. Let's fix it. Thank you very much. I'm gone.
Tracey:You're on your way.
Marc:You know, most of the time, we'll be a little bit more intentional with the timing of these visits so we can try and build in a little bit of time or at least, if nothing else, we're not having it be a problem based focus so that that conversation can be tell me a little bit more about you. Mhmm. You know, tell me about your, you know, your current life. Tell me about family around you. Tell me about the family history that you have.
Marc:Because all of this is pertinent to recommendations we can make, but a lot of it is a chance that we don't often get in medicine, especially when it's all reactive, to really get to know somebody.
Tracey:I'm sure that's how you also get to know families. You know, as a primary care provider, you're seeing maybe multiple members from the same household, and that allows you to connect those dots and understand that environment even more.
Marc:Right. Because there's a lot of shared history that's that goes on that way medically, but so much that's probably an understatement. All of medicine happens in a social context. Right? We we've learned this the hard way because we've we've often we are so hyperclinical.
Marc:But, really, if we're gonna connect with people, if we're gonna do good work, we can't pretend that it's not in the context of what do things look like in life outside. You know, what is what is beyond their lab numbers? What is beyond their medications that they're taking? What is what's, you know, not just their allergy list? All these things are important, but they're not really what we walk around identifying ourselves as.
Marc:And if we go in to see somebody who's gonna get to know us and really help us be strategic, you need that bigger context.
Tracey:That's great. That's very helpful.
Marc:So a lot of our purposeful time in these strategic visits is talking about what is good to proactively do and what is maybe best to intentionally leave alone, not because we don't care about it or we're dismissive about it, but are we any better at figuring things out if we're sitting here having a conversation and you feel okay versus something that's going to be more valid and more credible if it's left to a problem related thing. Can I listen to your heart and tell you that you're gonna do great versus tell me about the 4 miles you walked yesterday? That's way more valuable than me sitting and listening to someone's heart for an hour. So if I can ask the right questions, if I can get the context, we often change the the scheme a little bit of what's valuable going forward. So it's it's a lot of on the fly kind of customization if we do it right.
Tracey:That's really interesting. Do you thinking about your contextualization of this being a strategic visit, is it more valuable to you, or does the patient get more out of it if they come prepared? I know I like to keep something on my phone and my notes that's just like, what are things that are, like, batting around my head that I wanna ask the next time I have my annual?
Marc:Of course.
Tracey:Is that helpful or does that take you down a path that maybe distracts from what you would have focused on?
Marc:Can I say yes to both?
Tracey:Yes. Right? So it's,
Marc:you know, there's always value in having somebody be prepared. And it may mean I mean, it happens frequently enough and hopefully, we can be polite and and fair about this. It may mean that we say, you know, we had this schedule for a physical, but I'm really concerned about what you just brought up. I think we may need to to shift to that, and I wanna focus on that. If somebody comes in for a physical and and they say, well, I've got a couple things on my list.
Marc:Entirely fair, much appreciated. If some of those things demand attention, and that's a lot of our obligation to people, we may need to shift and say, let's have the strategic visit next month Mhmm. Or in 3 months. I'm really worried about that right now. I'm glad you're here.
Marc:Let's tackle that and we can shift. So there's a there's a blessing and a curse in a list, because it's it's also not quite typical that people are gonna have nothing on their mind, and then they just go to the doctor. It's too much of a time commitment. There's cost. There's usually an investment that's helpful in that, but we get what we get.
Sam:I mean, to that point, you know, practically speaking, what is the average length of time for an assigned annual? And I mean, I'm asking maybe for obvious reasons, but Yeah. Follow-up question. But how long is the visit? Well Generally speaking.
Marc:In the context of current climate and and insurance and typical practices, 20 to 30 minutes is is about as long as we'll usually get.
Sam:Yeah. I mean, I'm thinking about that timeline you're talking about, which and in the context of what Tracy just asked, perhaps for the patient who comes in who says, I literally got no issues Mhmm. Or no health history. And so the perfunctory part, the physical exam, etcetera, you can get through pretty quickly.
Marc:Right.
Sam:It probably leaves a little bit of room in those visits for, hey, I hear all this talk about vitamin d. What's the deal with vitamin d? Can you tell me about that? Versus perhaps someone else where there's a little bit more that you have to do in that visit. So just curious how that plays into your planning or timeline of the visit.
Marc:I think a lot of it is gonna be defined by the first couple minutes of getting to know somebody. I mean, this is where it's always it's always far more difficult if this is your first visit. If I've got people that I've known and seen for years, we've been able to kind of already establish what some of those curious questions is or we can do do them on the fly. So even if somebody comes in and says, I've got no issues. Great.
Marc:You know, I the odds the odds of them leaving that visit satisfied have gone up considerably because we've met their needs. And then I have a chance to then say, great. I'd like to partner with you for the future, and I wanna be able to make a case to you for, you know, if you're such and such an age now. In 3 years, this is what we're gonna do. In 4 years, this is what we're gonna, you know, this is what we're gonna look at.
Marc:Let's talk about immunizations. Let's talk about cancer screening. Let's talk about, and goodness knows we're terrible at this, but let's talk about current lifestyle issues, like how's sleep? How's exercise? Is alcohol problematic for you?
Marc:You know, certainly, do you smoke, and can I beg you to stop? All of those things, we can fill the time with good elements. So it's a lot of it is being selective and kinda tailoring it to the needs and the preferences of the person. I think that's that's the hard part on the doctor's side.
Sam:You're gonna guide some of this because I certainly I'm not gonna be able to pick out of this 3 hours worth of Yeah. Screenings that I'm supposed to be doing.
Marc:So Yeah. I don't I don't have a 20 minute conversation. Should we or should we not get a PSA for you to a 25 year old guy? Right. Right?
Marc:It's not salient. It's not pertinent. So a lot of it is being strategic with what are the time needs. Now if that 25 year old guy says, hey, nice to meet you. I'm scared because my dad and my brother just got diagnosed with prostate cancer, you know, 1 in the sixties and my brother's, you know, 35.
Marc:Conversation changes immediately. Yep. Right? And it should.
Tracey:And it should. Exactly. Yeah. That makes sense. One of the things that I know that we've done here at Innova is roll out depression screening Mhmm.
Marc:Over the
Tracey:last 12 months, universal depression screening. Talk a bit a little bit about how that comes to light in a physical and what that leads
Marc:to? It's an interesting thing that we're trying a lot of different ways to do this because I've there's a better conversation about mental health globally, culturally, and I think medically, we've generally not done a great job of incorporating this into traditional wellness primary care type stuff. We're I think we're getting much much better at it and we're we're paying attention to it now, but to have a better conversation globally is a nice thing. Have systems and have governmental attention to all this. We can do that in a lot of different ways.
Marc:Many times, if somebody schedules physical, they may actually get a questionnaire beforehand, you know, using using a MyChart function or an EHR function, that asks them to go through a series of questions. And we've got standard tools that really help in a way that's not terribly impersonal or takes 30 minutes to kinda say, is there something we can be helpful with based on a real real fear? Some of them are as small as 2 questions, Some of them are a little bit broader with 9 questions or 15 questions, and we can target certain audiences. So you get a different questionnaire if you're a 16 year old female versus a 49 year old male. So sometimes for people filling out a couple simple questions is safer than being stared at and ask, do you feel like you're depressed?
Marc:Right. Have you ever any thoughts about suicide or self harm? That can be if it's if it's someone you just met especially, that can be a really really awkward moment. And so trying to find ways where it can be done safely, sometimes it's before the visit, sometimes, you know, a nurse or a medical assistant can ask through those questions because they, you know, they're setting up a cordial tone with somebody. They can run through some of those questions as well, but it's the stakes are too high for us to miss any opportunity if somebody's in a dangerous spot that way.
Marc:So depression screening, you know, and really as a you know, there's a lot of breadth to that, whether we're trying to protect against suicide, whether just we're just trying to minimize the damage of somebody going through isolation and feeling a lot of these emotional challenges. None of those are good things. And we also know that they have a huge impact on the rest of our health issues. So as opposed to, well, I just won't ask about that. I'm gonna stick to your cholesterol and your diabetes screening because that's easy for me.
Marc:We need to be more comprehensive about that because if someone is struggling with depression, anxiety, we also know that it's a lot harder for us to be successful in the management of of of diabetes and cholesterol.
Tracey:That's right.
Marc:You know, it just we can't separate those things, so we should not when people are are actually encountering care. Well and
Tracey:I think that's a big part of breaking down the stigma. Right? Physical health, mental health, social health, all of that goes hand in hand. It's the more we can wrap it together in that annual physical, it becomes commonplace.
Marc:Right. So we have to be somewhat selective. That's why the physical is a valuable time frame because, generally, you know, within the primary care, if someone has depression, I want to know about it because I can help them work on that.
Tracey:You kinda lead me to another question, which is I've noticed in my own physicians, and I wonder if this is sort of just like a cultural change or if it's something that it just depends on each doctor is unique, but how forthright versus tiptoeing around certain issues are you with a patient? Say somebody that comes in to you for the first time that might be clearly overweight. Mhmm. Are you gonna tell them, like, I I'm noticing this, and that you need to make some lifestyle changes, Or are you gonna talk to them about, are you exercising? Are you eating right?
Tracey:This is a little high. I'd like you to think about addressing it. Let me know if you want my help with that.
Marc:Yeah. I think there's a balance there where it's not tiptoeing. I think more of it is acknowledgment. We I historically, I think we're trying to get away from this real patriarchal and patronizing tone of of we we've got all this figured out and you don't know it until I tell you that. Right?
Marc:It's silly. It's a fallacy to think that somebody who's navigating weight challenges doesn't know that when they come in. This is why a lot of people don't go to the doctor.
Tracey:Don't come in. Right. Exactly. They don't wanna have that conversation. We we
Marc:have to get past that altogether. And I think the challenge tiptoeing maybe is a good way to say, we need to be humane. We need to be tactful. We need to be self aware. You know, physicians who have our own health journeys that we're trying to go through.
Marc:So trying to kind of normalize that, destigmatize that is a good thing. Because whether it's weight, whether it's depression, all of these things that have historically been really challenging things, that's a problem. How we approach those things, how we bring it up, how we talk about it. You know, do we need to say, oh, you know, you're you're struggling with obesity. That's really impertinent in most cases.
Marc:But we we can ask is, you know, do you do you have any questions about that? Do are there things that you think you have questions about? Are there strategies that have worked for you or have not worked? Let's build on that. We can work on that.
Marc:And sometimes we may say, is this something that you want to address today? Because we're not always in control. That's the other fallacy that we have in being quite patronizing in this. We don't always get to direct it. I can bring it up.
Marc:But if if someone says, listen, I just came to see you because my elbow hurts or I wanna get my colonoscopy scheduled, I don't need to be told that I have all these struggles. Hello. I live in my body.
Tracey:Right.
Marc:I think there's there's a You take
Tracey:your cues from them too.
Marc:You you should. You should. And I think if we do it right, there can be a respectful way of doing that. If it comes off as tiptoeing, then we're probably not doing it quite well. So we kinda build things into systems to where we can be more artful about that, be more tactful about it, but not avoid it.
Tracey:That's great.
Marc:Mark, when
Sam:are you generally recommending that people actually start this annual physical journey?
Marc:I mean,
Sam:is this just adulthood, 18 years old, 21 years old Well including kids.
Marc:And by that time, I mean, if we wanna have a conversation with our pediatric colleagues and family medicine, we obviously see kids. We we can make a better argument, obviously, for shorter intervals for annual wellness exams for kids because there's so much changing Mhmm. You know, from year to year, growth parameters, social things, you know, depression screening, all of those kind of things. That's that's an easier scientific argument to make. So it's not as if we only start paying attention at 18, certainly not in in family medicine.
Marc:But if we broaden that to primary care, whether it's our pediatric colleagues, our internal medicine colleagues, family medicine, we we we we cheat and we see the whole spectrum. That interval is actually a lot better substantiated in those younger phases. And we can also there's kind of a biphase of curve here too. We can make a better argument for some of that as we get a little bit older. I don't spend a lot of time making a hard case to every 22 year old that they gotta come see me every year.
Marc:That's not generally
Sam:valuable. Any kind of final words of wisdom, Mark Childress mantras that you would love to share?
Marc:You know, having good conversations, establishing good habits, you know, exercise and sleep are so underappreciated in the world we live in today. You know, and diet, obvious I think we've gotten a little bit better about that conversation, but, you know, especially in this community, this is a hard driven, busier than anybody you've ever heard of kind of community. Time for that appropriate self care. And we, you know, we often have terms like self care. That sounds almost selfish.
Marc:Well, what if we paint it bigger than that? This is actually the best medicine that can be done. I can't compete as as good as I'd like to think I am. I can't medicate or or test beyond someone's capacity to rest well, eat well, and exercise well. Those, as simple as they are, they require time.
Marc:They require attention. That's still profoundly powerful medicine.
Sam:Well, Well, I'll make that the mantra then. I cannot compete with your self care. Let's make that your line. I like it.
Tracey:I like that. I'm gonna use that too.
Sam:Tracy, any final words from you?
Tracey:No. Thank you, doctor Childress. This was so insightful, and we're just really appreciative of you joining us today and shedding light on the wellness check and why why it's important to do that annually.
Marc:My pleasure. I appreciate it.
Sam:Thanks again, Mark. Well, that's all for today for our episode of should I call a doctor? We hope that our listeners found this discussion valuable, and we hope that you will follow the advice to prioritize your health and your self care. Let's know if you have any questions or topics you'd like us to discuss in the future, and we obviously there's a lot of things that we couldn't cover, with more specificity, and we will make sure that those resources on screening recommendations, etcetera, are available to you. So until next time, take care of yourselves and your family.
Tracey:Thanks for tuning in. We hope you enjoyed this episode. If you liked what you heard, be sure to subscribe.