The old adage, “An ounce of prevention is worth a pound of cure,” becomes more meaningful every day.
As ob/gyns, we are often the primary care providers for many of our patients. This designation allows us the unique privilege and responsibility of providing optimal medical care to women of all ages and all walks of life. In doing so, we must help women recognize that preventive care is just as important as point of care.
The Affordable Care Act (ACA) has made it even easier for women to obtain and afford an annual well-woman visit. As providers, we should also have mechanisms in place that not only remind women when it’s time for their “annuals” but also facilitates the appointment process.
The annual health assessment is a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician-patient relationship. Many of the buzz words in the health industry today, such as prevention, nutrition, life coach, wellness centers, physical therapy, and yoga, have a cornerstone in the annual wellness exam.
The ACA mandates that insurers cover key preventive services without co-pays or deductibles. Among the gynecological services covered are:
- Well Woman Visits (at least 1 annually).
- All FDA-approved contraceptive methods and contraceptive counseling.
- Pap tests.
- HIV and other STD screening and counseling.
- Domestic violence screening and counseling.
Additional preventive services that must be “offered” but can involve co-pays are:
- BRCA testing and counseling.
- Osteoporosis screening after age 60 for women without risk factors.
- Tobacco use screening, treatments, and counseling.
The Annual Well-Woman Exam
It’s beneficial to women that an annual gynecological exam is covered fully. As gyn providers, the annual visit is the perfect opportunity to detect and help correct medical problems. Every visit also provides physicians the opportunity to counsel and even teach patients how to maintain their health.
To that end, each well-woman visit should have 4 components:
2. Laboratory and other tests.
3. Evaluation and counseling.
There are age-specific tests for women 13 to 18 years, 19 to 39 years, 40 to 64 years, and older than 65 years explained in detail here.
The Physical Exam
The physical exam (PE) is integral to the evaluation portion of the annual visit. The actual components of the PE will vary depending on the patient’s age, risk factors, and preferences. In general, however, the PE should include:
- Updated personal history (medical and social).
- Updated family history (particularly of cancer, cardiovascular disease, and psychiatric).
- Weight, height, and BMI.
- Assessment of overall health.
- Abdominal exam.
- Clinical breast exam. (Note: ACOG and the American Cancer Society both agree that a clinical breast exam should be done annually in women 40 and older. I perform it on every patient regardless of age, since breast self-awareness education is for all ages.)
- Pelvic exam.