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Dr. Aaron Carroll answers Hank's questions about what you should do at a doctor's appointment, what "catastrophic coverage" means, and how necessary it is to even have a doctor.

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[Upbeat music]

Hank: Hello, it's how to adult, and today we're talking with healthcare policy expert and doctor of doctoring, medicine, Aaron Carroll. Is that what it is?
Aaron: Pediatrics
H: Oh
A: I'm a pediatrician
H: You take care of the kids. How are they?
A: Yes, in fact, they're doing well. They're doing great.
H: Your kids or kids in general?
A: I meant kids in general, in fact. That's a going theme we talk about on our show all the time, by almost metric you can measure kids are doing fantastic. 
H: My kid is about to get his 12-month vaccines, and this will be the first time I give him a vaccine where he's gonna kinda know what's going on. 
A: He still won't remember them. 
H: No, I'm not worried about him remembering, I'm worried about him looking at me with the eyes of like, "Why have you allowed this to happen to me, dad?"
A: That's possible, but I still say until you're laying down permanent memories everything you do is excusable. You still got a few years. 
H: That doesn't sound like what a pediatrician should be telling me. 
A: That's also what a parent will tell you. You're good for a few more years. You got a few more years of do-overs. 
H: Aw man. Well, good. Well, now there's much less pressure. 
A: Good
H: But vaccines are good
A: Unequivocal good. Probably one of the best things we've ever done for public health. 
H: What do you think are the hardest things, especially in America, when you're coming out of your parents' wings in terms of healthcare.
A: I think the biggest thing is first establishing yourself and seeing a doctor that's not your pediatrician, not the person your parents picked out for you. 
H: I only very recently as a 37-year-old got a primary care physician. Because I have my GI doctor, who I was like, "I see this guy once a year and he's handling the major problems of my health." But I went ahead and did it if I don't have a primary care physician and I want to go see a doctor, is it okay to see whoever's at the walk-in clinic that day?
A: Yeah, as a matter of fact, you can often strike it rich and find a really great doctor that way. But I would say, still, your best bet is you take a doctor like you pick anything else, talk to your friends, talk to people who have a doctor they like. You're looking for things that are different for you, you're trying to screen.
H: But, is it, maybe I don't feel like I need a doctor. Do I?
A: I think that everyone should have one in their back pocket. 
H: Somebody that I have a relationship with? Instead of just going to the walk-in clinic and being like, "Hello, person who is here right now."
A: Correct, because I think it's just easier when you have an established rapport with, you can talk to, that might know something about your history and your preferences.
H: I often, by the time I go to the doctor I'm like, "Okay, I've brought you this list that's like 8 things long. My hip hurts every once in a while, I don't know what that's about, is that normal?" And they're like, "Well, uhh."
A: I don't think, I don't want to say you're not normal, but I don't think most people do that at this age. 
H: How do I make the most out of a doctor's visit?
A: So I think what you do is not actually a bad idea if you go in with a plan. To know, "These are the things I want to talk about."
H: Instead, if it's a yearly checkup, you're like do what you do to me and tell me if I'm sick." 
A: Exactly, that's how I go to the doctor. I just sit there and answer questions. I offer nothing, almost like I'm at the stand and they're cross-examining me. Going back to your question of how you make the most of it, I think it's having a list, knowing what you want to talk about, not letting your doctor drive the conversation. Making sure you get to the things you think are important. Doctors are overwhelmed, there's a list of things they're supposed to do at every visit that is enormous and impossible. There have been studies that show in adult medicine if they adhered to every guideline that exists, visits would take like 16 hours long. It's just not possible to actually get to everything they're supposed to, so they have to prioritize and often doctors are creatures of habit, they'll hit the things that are important to them, but maybe not the things that are important to you. Making sure that those things happen is important. 
H: So when I go and there's sort of a, which I guess I know this when I go to a checkup, which I do now, but didn't for a long time, there's sort of a "these are the things that we do." That's not based on me, it's based on guidelines and recommendations. 
A: Well, you hope. Sometimes it's not. Let's be honest, some doctors are great and some doctors are not. Some doctors are just doing what they think is right, even if it's not based on guidelines or evidence. I'd say your best doctors are trying to stick to at least the evidence-based and what we know we should be tackling. 
H: What do I want my doctor to do to me when I go to a checkup?
A: I think a lot of it depends on the age and what risk factors you have. A lot of it is what we call in the pediatric world anticipatory guidance, of you know, "As your child ages, we know, now he's mobile, we have to worry about things that you need to. He might get into water or turn on the faucet and get burned." A lot of it is trying to anticipate where the high-risk things are coming from. A lot of that is dependant on do you have certain diseases, do you engage in certain risky activities? It's sex, it's alcohol, it's drugs, it's things like that. Those might shift your doctor into talking about some things. Otherwise, a lot of it is going to be diet, it's going to be nutrition, exercise, things we all know we should do. It's going to be a physical exam, where they're trying to see if anything if wrong, but most of the evidence says the physical exam is really not useful. The number of things that you picked up that you otherwise would is really small, which has led some people to say we don't need as much primary care as we once needed.