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William M. Gilkison, MD, is a family physician
in Greenwood, Indiana.
some of The United States Preventive Services Task Force (USPSTF) recommendations cause confusion among patients and physicians and lull them into a complacent attitude toward preventive care.
William M. Gilkison, MDThe United States Preventive Services Task Force (USPSTF) was established in 1984 as an independent panel of experts whose goal was to establish guidelines for preventive services for use by the medical profession and patients. The panel is comprised of 16 individuals, many of whom are practicing clinicians and all of whom have expertise in certain preventive disciplines.
In so doing it provides the medical profession and the public with specific guidelines for offering such services. But in my opinion, some of its recommendations cause confusion among patients and physicians and lull them into a complacent attitude toward preventive care.
The USPSTF lists 96 different conditions for which it has published recommendations. But nowhere is there any recommendation on how often to have a general checkup, or even whether to have one. The task force doesn’t touch that subject, because despite its denial that recommendations are made without concern for cost-effectiveness, the “annual physical” is usually not covered by insurance or considered cost-effective. But every patient who, as a result of a checkup, has been found to have some abnormality for which they were asymptomatic feels it was money well spent.
In the early 1970s, clinical staff and faculty professors in my family medicine residency were vigorously promoting the annual checkup as an effective, logical means for patients to become part of the “medical system” and have their health needs addressed. We residents found that to be a great idea and a meaningful change from the episodic care delivered for decades.
It was an uphill battle, but one that physicians were winning. In my practice of 40 years, I did two to four adult complete physicals, and numerous Pap smears, pelvics and breast exams, four days each week, to provide my patients with the best preventive care I could offer. It seemed to be very effective, and patients were appreciative and compliant in scheduling each year.
Then along came the USPSTF, and the preventive care paradigm shifted.
Suddenly, mammograms were more harmful than helpful because they led to unnecessary additional mammogram views and biopsies. Prostate-specific antigens (PSAs) were taboo, too, because they led to “unnecessary” prostate biopsies. Pap smears were no longer helpful for finding cervical cancer and were done too frequently to be cost-effective.
In short, just when the medical profession was influencing the preventive medicine attitudes of Americans, the USPSTF recommended against services that had become commonplace and widely accepted.
The USPSTF has earned the respect of healthcare providers in all clinical disciplines, and provides helpful guidelines for performing preventive services. Certainly, the vast majority of the USPSTF’s recommendations are sensible and noncontroversial, because they are well-proven and time-tested. For years, however, many people also accepted as truth the benefits of mammography, PSA testing Pap smears, and the annual exam. As a result, patients have become confused about what is right for their care.
As guidelines change, the time between essential procedures lengthens, increasing the risk of missing changes in a patient’s health.
I think these time lapses are a disservice to patients, because they begin to adopt a “if I don’t feel bad, I must be OK” approach to health screenings. It is the duty of every healthcare professional to know the health history and lifestyle of all patients and advocate on their behalf for appropriate screenings based on that knowledge, in spite of USPSTF guidelines, because they are just that, guidelines. The public is better served with this attitude.