Healthcare Archive

Ask the Doctor

Most large employers now offer financial incentives to workers who make healthy lifestyle changes. 
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Q. My employer is offering employees financial rewards if we lose weight. At first, I was shocked by this, but then I thought it might be a good thing for me, and for my employer. Does this kind of financial incentive lead to healthier lifestyles?

Ask the Doctor

Q. I've found lately that when I make a routine appointment with my doctor's office, I may be seen by a physician assistant or nurse practitioner instead of my doctor. I really don't have any complaints, but I'm wondering why they seem to be taking on things that my doctor used to handle. Is this a new trend?

A. In my practice, many patients see a nurse practitioner instead of me. The appointment might be for an initial visit to get established in the practice, for routine prenatal care, for an urgent issue such as a miscarriage, or for bothersome symptoms such as those from a persistent yeast infection. If a woman has complex medical issues, the nurse practitioner immediately consults me, and together we decide the best next steps.

Getting a living will, health care proxy, or other advance directive now will give you more power over your treatment later.

Talking to you loved ones about your wishes for future medical care is key to ensuring you choices are respected.
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You've probably heard of a living will, a legal document that allows you to specify the kind of medical care you'd like at the end of life. But who'll make sure those wishes are carried out? And what if you need someone to make your health care decisions long before life's end?

In January the Department of Health and Human Services released new guidelines outlining patients' rights to their own medical records.

Ask the doctors

Q: I went for my usual check-up, and in addition to taking my blood pressure, the medical assistant handed me a form to fill out with nine questions related to my mental health. I've never had this happen before. Is this new?

A: Yes, it is new for most people. The U.S. Preventive Services Task Force (USPSTF) has just released an important depression screening recommendation. The USPSTF recommends regular depression screening for all adults, which is a modification from advice originally given in 2009, in which screening was recommended only for clinics or doctors who had adequate support systems to provide mental health care for those who were identified with depression. Since that time, multiple studies have found that mental health care from primary care clinicians works very well, and probably just as well as specialist care from psychiatrists. That isn't to say we don't need care from psychiatrists, but rather that not everyone needs a psychiatrist, especially those with mild to moderate depression.

Your primary care provider should help you control risks for heart disease and refer you to a cardiologist if needed.

Any primary care provider you see—a doctor, nurse practitioner, or physician's assistant—should offer detailed advice on how to lessen your odds of cardiovascular disease, which is responsible for one in three deaths in the United States. However, some people need more specialized care for their hearts.

"I see or hear from a lot of people who have very common problems, like high cholesterol and high blood pressure, who think they need to see a cardiologist," says Dr. Patrick O'Gara, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. For many people, a primary care physician can effectively manage those problems. But if you have specific concerns, talk to your doctor about whether more specialized care might be beneficial, says Dr. O'Gara.

They're convenient and affordable, but they don't replace a relationship with a primary care physician.

Walk into a drugstore, supermarket, or "big box" store these days, and you'll find more than prescriptions, food, and household goods. Many now feature health clinics. They're part of the big trend of making health care more convenient. "Twenty years ago you had to go to an emergency department if you got sick and needed immediate care. Now we have an explosion of options, such as retail health clinics," says Dr. Ateev Mehrotra, a researcher on the topic and an associate professor of health care policy at Harvard Medical School.

The clinics

Retail health clinics began showing up about 15 years ago. Today, there are about 2,000 clinics across the United States, mostly in large retail chain settings. A typical clinic is open from 7 a.m. to 7 p.m., seven days a week, and is staffed by a nurse practitioner or a physician assistant. Clinics offer all kinds of health services—everything from treating minor illness like a cold, pinkeye, or a urinary tract infection to providing physicals, health screenings, lab work, smoking cessation help, and vaccinations.