Primary Care for the 20 Something Generation

I was asked this week to comment on the status of primary care for those in their twenties.  I am using my answer for this weeks' post.  For more information and discussion on this topic click here.

Should 20-Somethings Have and See a Primary Care Doctor?
I am obviously biased in regards to this question, but yes, absolutely.  Do they need to go for frequent check ups if they are otherwise healthy?  No, they do not.  Early on in the twenties is a great time to establish a relationship with a doctor who can help guide them through their health for the decades to come.  For young women who are otherwise healthy, this may be their gynecologist.  An Internal Medicine physician is certainly appropriate.  That first visit is important to first establish a relationship.  That way, when illness or injury comes along, there is someone ready to help.  Secondly, it is a chance to evaluate one's health habits.  This decade is a critical time for establishing healthy habits which will endure a life time.  The human body goes through a big change in those years.  The ever active metabolism characteristic of adolescence simmers down to a slowly declining  state.  If anticipated and accounted for with dietary changes, the not so unusual 15-20 pound weight gain can be avoided.  It is much easier to maintain body weight than it is to spend the rest of your life trying to lose it.

Are Young People a Drain on the Health Care System?
Not at all.  In fact, young healthy people are viewed as one of the keys to controlling health care costs and being able to provide health care for our entire population.  If we did not have young, healthy people carry insurance, all of us will pay a larger price.  That said, if young people do not have a primary care physician established, they will present to emergency rooms with conditions which could easily be evaluated in a physician's office.  The cost of emergency care is exponentially higher than it is in the primary care setting.

What Tests Do Young People Need to Get?
In the absence of any concerning symptoms or physical findings the most important "test" to be done is that initial history and physical examination.  More than any battery of tests, that first visit will help guide the physician to tailor any testing to the needs of the individual.  If it has not been done previously, I recommend at least a total cholesterol level as a baseline.  A family history of diabetes may prompt testing for blood sugar.  Symptoms of fatigue in a woman with heavy menstrual cycles would prompt a test looking for anemia.  However, from a purely routine standpoint, that initial visit carries the most weight.

Do Doctors See a Difference in the Way in which 20-somethings Approach Health Compared to Older Generations?
I don't think a broad generalization is possible here.  I know many young adults who take exceptionally good care of themselves and are extremely health conscious.  I also just met a young woman who basically eats junk food for all three of her meals a day.  She starts with a pop tart.  Chips and soda often pass for lunch and she may finish at Taco Bell that night.  I do think that elderly patients think of their health a lot more but this is because they are now suffering from many more conditions than before.  Some ailments come as a natural result of aging but many could have been prevented had they cared for their health better when they were younger.