When it comes to routine screenings, ‘fear of the doctor’ is not so healthy

Fans of classic rock-and-roll likely remember Warren Zevon. A Los Angeles-area musician with a career that spanned three decades, Zevon was perhaps most famous for the irreverent and humorous rock hit “Werewolves of London.” He also wrote a number of songs made famous by other artists, including the 1970’s anthem “Poor Poor Pitiful Me,” and appeared on The Late Show with David Letterman with frequency.

In the early 2000s, Zevon announced that he had been diagnosed with mesothelioma, a form of cancer most closely associated with exposure to asbestos, and was immediately declared terminal. In what would become his final appearance on Letterman – a poignant episode, because Zevon and Letterman were close friends  – Letterman asked him, “What happened?”

Zevon’s answer to that question was as his music: humorous, irreverent, sharply observant. “Well,” he mused while facing his own mortality, “I suppose I could have made a tactical error by not seeing a doctor for 20 years.”

Let’s be honest: Whether it’s “White Coat Fever” — where your blood pressure goes up 20 points just by being in a doctor’s office -– “Warren Zevon Syndrome” or whatever else it may be called, many of us have a fear of seeing the doctor.  Tests, scans, screenings… the equipment can look frightening, the tests can be uncomfortable, and there’s the uncertainty of actually getting the results: what happens if the result is positive?

Unfortunately, there’s some evidence that when it comes to getting routine screenings, many of the Fresno Unified School District’s (FUSD) health plan participants are letting those fears get the best of them.

For example, according to statistics gathered by the FUSD and its Joint Health Management Board (JHMB), the number of benefits plan participants who actually have routine screenings performed lags behind benchmarks among similar groups in many categories. And the screening rates are getting worse — a disturbing trend for the FUSD’s benefits-plan participants.

The details? In the most recent plan year, approximately one- quarter of plan participants who should have gotten their routine screening for cervical cancer did not do so. And the numbers are even worse for mammograms: among FUSD Benefits Plan participants, more than half of women for whom a mammogram is recommended did not get one. And this is despite having such routine screenings covered within the FUSD’s benefits plan as part of an annual physical.

So why is this important? First, the simple reality is that getting those routine screenings is important to your overall health. Problems cannot be addressed until they’re detected, and mammograms, Pap smears, colorectal tests and other similar routine screenings are among the most effective ways to detect problems early. And as you’ve heard, the kinds of problems those tests detect are far easier to treat when they are caught early.

Second, while the primary concern is always the health of plan participants, not having these kinds of screenings performed can contribute to higher healthcare expenses for all plan participants. And while that might not seem intuitive – after all, wouldn’t skipping a screening save expenses for the plan? —  statistics gathered by the FUSD and JHMB show that missed screenings are one factor that can lead to higher long-term medical costs.

“What we’ve found in our research is that non-utilizers – plan participants who don’t have these kinds of routine screenings performed – tend to become heavy utilizers of healthcare benefits later on,’ said Devon Devine, Practice Leader with Claremont Partners, an organization that collects data to track the performance of the FUSD’s healthcare benefits for plan participants.

This has to do with the fact that illnesses detected later are almost always more complicated to treat, and therefore more expensive to manage. For example, consider skin cancer. Often times, certain kinds of skin cancers can be handled in simpler, in-office procedures, many of which require no serious after-care other than follow-up. But skin cancers left undetected and untreated can spread, requiring far more extensive, expensive, painful procedures and treatments.

And this does not even consider the human cost  — the pain, the emotional toll on patients, their families and their loved ones — of those more extensive treatments.
“Just by the numbers, heavy utilizers of benefits tend to drive costs up for all of the members,” Devon added. “It’s something we all can help to prevent by taking advantage of the plan’s routine screening benefits when you go for your annual physical.”

Finally, these kinds of routine screenings save lives. Consider Gail Fry, a teacher in the Fresno Unified School District, who tells the story of how a routine screening saved her life.

Warren Zevon died in 2004, in his musical prime, two weeks after the birth of his twin grandchildren. He may have missed the best time of his life, perhaps because he let his fears get the best of him.

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