Let’s Get Back to Health Screenings with Terrence Steyer, M.D.

Taking extra precautions to stay safe during the COVID-19 pandemic has caused some to steer clear or put off routine healthcare visits for themselves and their children. In this episode of Advance with MUSC Health, Terrence Steyer, M.D., chair of the Department of Family Medicine at MUSC Health, explains why it is time to come back for regular visits, preventive health screenings and specialist visits. He also stresses the importance of getting the COVID-19 vaccines for those who have not yet had the shot.

“There's so much disease that can occur and happen if we're not doing routine screening … If you're really nervous about coming in to see a physician, we offer telemedicine services where we can provide preventive services via video. If you don't have the technology in your home, we can actually use your telephone to help do that. And we're able to screen people for things like colorectal cancer without having (the patient) come into the office.”
-Terrence Steyer, M.D.

Topics Covered in This Show

• The decline in routine health care visits across the country during the COVID-19 pandemic.
• The importance of annual wellness check-ins and physicals to screen for problems such as breast or colon cancer.
• How MUSC Health addressed the problem of underrepresented minorities and lower income people going back for screenings at a lower rate than white people.
• COVID-19 hesitancy and how Dr. Steyer communicates with patients who are hesitant.
• How hospitalized COVID-19 patients can delay care for other patients with other health conditions.
• Why it is important for children to continue getting well child visits to stay ahead of any developmental issues that could arise.
• The importance of getting the influenza shot.
• Steyer shares his personal story of getting COVID-19 despite being vaccinated and explains that his case was mild because of being vaccinated.
• The mental health aspects of quarantine with COVID-19

Read the show transcript below

Erin Spain, MS [00:00:04] Welcome to Advance with MUSC Health, I'm your host Erin Spain. This show's mission is to help you find ways to preserve and optimize health and get the care you need to live while taking extra precautions to stay safe during the COVID-19 pandemic has caused some to steer clear or put off routine health care visits for themselves and their children. But MUSC Health Dr. Terrence Steyer says it's time to come back. Come back for, well, child visits, preventive health screening, specialist visits and routine immunizations. Dr. Steyer, the chair of the Department of Family Medicine at MUSC health and joins me today. Thanks so much for being here.

Terrence Steyer, M.D. [00:00:45] Thanks for having me, Erin.

Erin Spain, MS [00:00:45] So you are passionate about providing health care to every member of a family. Tell me about your work and why you love family medicine,

Terrence Steyer, M.D. [00:00:54] Family medicine, the discipline, that's actually one of the newer disciplines in terms of board certification. It's only about 50 years old, really. It's back to the old times of Marcus Welby, M.D., that doc that everyone went to in a community that they could identify as their personal physician. I love family medicine every day because I get to take care of multiple generations of a family. I saw one yesterday and actually saw three generations of the family all on the same day. So, in addition to dealing with their medical problems, some of which are complex and some of which are simple, I also get to understand the family dynamics and how those relationships affect people's health. It's really gratifying. After you've done this for 20 years, I'm actually now taking care of children of children I used to take care of here in Charleston. And so, it's a great experience for me and something that makes me passionate and just love to get up every morning and come to work.

Erin Spain, MS [00:01:41] Well, let's talk about what's happened with family medicine in the past year and a half or so and your own clinic. And around the country, there's been a dramatic decline and routine health care visits now at the start of the pandemic. This was for very good and practical reasons. But what's happening now with routine health care visits, are you seeing people come back at the rate that you would like to see?

Terrence Steyer, M.D. [00:02:02] We're beginning to see an increase of people coming back into the office for routine preventive care. One of the things in family medicine is that we focus not only on the care of patients who are sick or who have chronic medical conditions but trying to prevent people from becoming ill and trying to stop things before they actually happen. For that reason, it's important for people to come in for routine care or annual wellness visits, annual physicals, as we call them, so that we can check on those measures that would help them prevent from getting serious disease such as cancer or heart attacks or strokes. We're beginning to see an uptick in those patients coming back in to get those services performed. It's scary in the times of a pandemic to come into an office where you're not sure if someone near you may have covered or not. So, we're doing all we can to keep people out of the waiting rooms and back into a clean clinic room as quickly as possible. And really, the view of going to a physician's office shouldn't scare people any more than perhaps going to the grocery store or to a drugstore to get the items that they need.

Erin Spain, MS [00:02:58] And it is important not to skip these visits, like you said, the annual physical or if you're not feeling well because a lot can happen. And just a year and a half of not going to the doctor told me about that.

Terrence Steyer, M.D. [00:03:10] There's so much disease that can occur and happen if we're not doing routine screening. A number of women have put off their routine screening. Mammograms and breast cancer can sometimes be aggressive and grow much quicker than we would anticipate or want. And so, if you wait 18 months or two years for that exam, it may be too long. Other conditions, for example, colorectal cancer screening. Well, there is one standard test, a colonoscopy, which everyone recommends is being the best way to get screened for colorectal cancer. There are other tests that don't require you to come to the doctor's office for a procedure. So even if you're really nervous about coming in to see a physician, we offer telemedicine services where we can provide preventive services via video. If you don't have the technology in your home, can actually use your telephone to help do that. And we're actually able to even screen people for things like colorectal cancer without even having to come into the office.

Erin Spain, MS [00:03:58] OK, so there's ways around it if you're still concerned and you can just make those appointments through the MyChart?

Terrence Steyer, M.D. [00:04:04] If you go in and use again, our MyChart portal for online appointments is open and available in primary care or calling directly into our patient access center, they can also help you get an appointment in a relatively timely manner to get those services that you need.

Erin Spain, MS [00:04:17] Hispanic, Latino and black adults, as well as those with lower incomes, are delaying care at even higher rates than whites, according to a report from the Robert Wood Johnson Foundation. What is your reaction to that?

Terrence Steyer, M.D. [00:04:28] This is really concerning underrepresented minorities and low-income patients already do less preventive services than others. There are probably multiple factors that caused that to happen, including lack of insurance or feelings of inadequate care that can sometimes occur. It's really important that all individuals come to preventive services, but especially those of underrepresented minorities, because we know there's disparities in both health in terms of the diseases that people get, but also the health care that they receive. That's been well studied in multiple reports from the National Academy of Medicine, as well as Robert Wood Johnson Foundation and the Kaiser Permanente Foundation has shown these to be true. It's really important for these individuals to get in. It's also important for them to find someone who they may connect with better. And so, we're very fortunate here at MUSC that we have a number of underrepresented minority primary care providers who can serve as patients, who want to find someone they can identify with, whether that be based upon their race, their gender, their sexual orientation. We have multiple providers who are willing to help work with you to make sure that you're getting care in an environment where you feel comfortable and safe to discuss all those issues that are happening for you.

Erin Spain, MS [00:05:31] Let's talk a little bit about vaccine hesitancy. Tell me how you talk to patients when they come in who have chosen not to get the COVID-19 vaccine, even though they are eligible based on their age. How do you counsel them? What do you say?

Terrence Steyer, M.D. [00:05:43] I try to understand. First of all, why are they hesitant to get the vaccine? What are their reasons? What are their beliefs behind that? Some of that are pretty easy to demystify. For example, the recent approval by the FDA of Pfizer of making a fully approved vaccine as opposed to for emergency use only. So, for individuals who are concerned that it was still on an experimental stage, that issue is now sort of behind us. And we can say, no, this is a fully approved vaccine. Others are concerned about the new technology that's being used with the special genetic vaccines that are being used, which is a little bit different than you would get from your typical annual flu shot. That vaccine technology has been around for 25 years, and which is first used here during COVID because it was a way to get the vaccine done in a much more time efficient manner. The vaccines are easier to produce this way. They don't need to incubate, et cetera, because we're using direct genetic material. A lot of patients are concerned that that genetic material stays in their bodies forever and it doesn't. It actually is absorbed by your cells and has gone in about six days. So, all these kinds of myths I try to work through those with individuals, try to really address their concerns and what they're afraid of, and try to leave politics at the door. And unfortunately, the COVID pandemic has become very politicized, in my opinion. And we just need to leave that at the door. And let's look at the evidence and the scientific proof that people have. If you have a trusting relationship with your primary care physician, hopefully we can help you overcome some of those vaccine hesitancy issues to get you so you're as protected as you can.

Erin Spain, MS [00:07:10] Because this is a very critical time right now. There are many hospitals that are absolutely overrun with COVID-19 patients, isn't that right?

Terrence Steyer, M.D. [00:07:18] Yeah, it's very frustrating, too, because we have so many COVID patients in the hospital. We aim to provide the best care we can to all individuals. And unfortunately, sometimes the waits too long for people to get the care they need. And so, individuals who may have another condition that typically would be handled very quickly in the emergency room, they're delaying their care because it's filled with COVID patients. A great example recently was an individual who came in with what we thought was appendicitis, went to the emergency room. There was a literally a 12 hour wait in the emergency room for her to receive care. So, she went home, came back the next day to our office. We were able to get her in for appropriate testing. And unfortunately, her appendix had ruptured overnight. So, while she still recovered and did OK, it certainly delayed things and caused her to have a different type of experience. So, getting the Cuban vaccine is not only a way to protect yourself from this horrible viral illness that individuals get that we know is worse if you're unvaccinated. But it also allows you to have the peace of mind that if you or another member of your family or a friend develop another illness, the resources are there in a timely manner to take care of you more quickly and more efficiently. For children, it's especially important for them to get in for their routine care because things happen so quickly in children and children. They're developing at a fast rate. They often need childhood vaccinations to go to school. And there's been a lot of controversy about kids in in the classroom. And you have to have your vaccines to be able to sit in the classroom and also just to make sure that they're developing and growing properly and meeting what we call the developmental milestones to make sure that we're not getting behind on any issues that may be occurring, that with early intervention would have a significant impact on them in the long term.

Erin Spain, MS [00:08:55] So what happens if a child does fall behind on a routine vaccine?

Terrence Steyer, M.D. [00:09:00] Well, we're fortunate in that we have guidelines from the Centers for Disease Control and Prevention on how to get children caught up on their vaccinations. If they do get behind, however, most schools will require that you have those vaccines up to date before you send your child into the classroom. And we're actually noticing that even being more prevalent with the schools being a lot more aware of what people's vaccinations are since the pandemic began, some schools are actually looking for those children who are over the age of 12 to see if they've been vaccinated as well. So those questions are being looked at more routinely. And so, we're able to we're seeing the need for children to come in and get vaccines if they are behind.

Erin Spain, MS [00:09:33] So it's almost flu season. Why now in this world of COVID-19 variants, is getting the flu shot so important?

Terrence Steyer, M.D. [00:09:41] You know, there's a couple of really important reasons to get the flu shot. Last year was a very low flu season. We were all in shock at the decreased number of flu cases we saw. In reality, that was probably due to the masking appropriate hand hygiene and hand sanitizer use and the isolation and quarantining we were doing for COVID this year with some of those guidelines not being there, people being. A little less cautious about wearing a mask and doing appropriate hand hygiene. We really anticipate this to be a large flu year. It's like looking in a crystal ball. We can't quite predict whether we're going to be right or not, but we're certainly anticipating that it's going to be a bad year for the flu. The flu vaccine has been out for many years. It's safe and effective. So, we're really highly encouraging everyone to get a flu vaccine this year. It's also notable that you can get a flu vaccine and a COVID booster at the same time. So, we're actually we're actually working here at MUSC to make sure that if you're coming in for that COVID booster, you can get your flu vaccine at the same time.

Erin Spain, MS [00:10:33] Because a worst-case scenario, if you have influenza and then you contract COVID-19 from one of these variants, what sort of combination would that be for a patient?

Terrence Steyer, M.D. [00:10:43] That could be severely devastating to any patient who would develop both at the same time? When COVID first became a pandemic about a year and a half ago, we actually thought that if you received if you were actively ill with COVID, that it wasn't likely that you had other illnesses like flu or strep throat or other things. We're now discovering that we were completely wrong on that. People can have covered and strep and flu all at the same time. And there's certainly been reports of those types of cases. Certainly, the most dangerous thing with COVID, as most people know, is the development of breathing problems and pneumonia, especially in the elderly and those who are immunocompromised. Those are the same complications you get from influenza. So, you think about putting those two together on the respiratory system. It could be incredibly devastating to anyone to get both. At the same time.

Erin Spain, MS [00:11:27] You have a personal story I hope you don't mind sharing, but you were fully vaccinated, and you were one of the individuals who did get COVID-19 after becoming vaccinated. Do you mind telling me about that experience?

Terrence Steyer, M.D. [00:11:40] My entire family was vaccinated. Both of my children were over the age of 12 and eligible for vaccine. And as my wife says, we're batting 500. Both myself and my son, six weeks apart, were infected with COVID. The good news, if there was anything with that, was that it was a very mild case. In my case, I had fever and cough for about 36 hours and then actually felt pretty good with some fatigue. Did the appropriate isolation actually discover that I was still infectious on day 11? So, I spent 14 days in isolation and the following week, despite being vaccinated and despite doing everything right with isolation, I developed a covered pneumonia, but fortunately was again able to fight that off with appropriate treatment and antibiotics. My son, who is 18, had a little bit easier course. He's a freshman in college. We sort of knew it was going to happen when he went to college. That would be a high risk of exposure. He came home and isolated for his full 10 days. He had again two days of fever, cough and GI symptoms and then now really just has some residual fatigue at day 14. So very fortunate that we were both extended, and both had very mild cases of the disease. It's just important to know that similar to flu, you can get the flu vaccine and still get the flu. It's just a much milder case. And we know that people end up in the hospital with COVID are those who are 95 percent of them today are unvaccinated. And currently there are zero patients in the ICU who are vaccinated. So even though you may still get covered with the vaccine, your disease course is likely to be much milder and something that's going to be tolerated. Honestly, the worst part about it and something that we don't talk about that much are the mental health effects of COVID and COVID disease isolating in a room for 14 days where you can't interact with very many people either by your phone or your iPad and face time, which were great things to be able to do, literally watching your loved ones, you know, drop food at your door and run for fear of getting ill and trying to keep them healthy. That's not something that I ever want to go through again. And I was fortunate that I had people at home to care for me and help me. I really worry about individuals who either live by themselves or are older and don't have those same social support resources that I had. How do they take care of themselves during a pandemic? How do you even get groceries during a pandemic? And sadly, we've seen individuals who have either come to the hospital or presented to our clinics after about with COVID, many of whom have lost 10 percent of their body weight because they had no way to get food during the pandemic. Those are the kind of things that we need to talk about. And again, another important reason why if we all get cowbird vaccines as a society, we can help these individuals lessen their risk of getting the disease, which therefore means you're helping your neighbors by just getting the vaccine in addition to helping yourself.

Erin Spain, MS [00:14:13] Well, thank you so much for sharing your story. I think it is important for people to hear that, yes, you can get it after you've been vaccinated, but your outcomes are good.

Terrence Steyer, M.D. [00:14:23] Yeah, very good. And I'd like to say I'm completely back to normal now. My wife says I'm still a little fatigued. Maybe that's just too much watching college football and the recliner.

Erin Spain, MS [00:14:33] Well, my final question for you today. What are some things you do to optimize your health and live well?

Terrence Steyer, M.D. [00:14:39] Sure. You know, it's so important to take care of yourself, and self-care is so essential every day, but especially during a pandemic. And I think you need to take care of all parts of your being, be that physical, emotional, spiritual, all of those areas. For me, I try to work out at least three to four times a week whether that's taking the dog for a vigorous walk or going to the pool swimming laps. Or even if it's just taking a walk around the neighborhood with my wife, those are all things that we enjoy to do in a way to sort of stay healthy and active. I think it's important that you find those things that you cherish and value and make sure you're spending time on those areas with the pandemic, it's so easy to get caught up in. Do I have the mask, or I have the hand sanitizer? Have I cleaned the house enough if I sprayed enough Lysol, one of the things that you value and so is that spending time with family or close friends that are in your COVID bubble or that you can go to go to a friend's house and socially distance wearing masks? Those are still things that we can do as a way to keep yourself healthy, both the emotional and physical pieces. I personally wake up every morning and think of the things I'm grateful for and sort of keep a gratitude journal of those things that I'm lucky to know and have as part of my life. And that helps me sort of keep things in perspective. It is so challenging to see individuals who get really sick really quick and a disease that's now completely preventable. I was on the COVID Wards before the vaccine came out and actually witnessed a person my age go from being like you and I to here talking. I was talking to her and four hours later she was on the ICU on a ventilator. It happens quickly and can be devastating. She had a great outcome and a great recovery. But now it's hard to see individuals who are suffering like she did and that I've seen personally when it's a completely or almost completely preventable disease. And so that's why we're just sort of implore everyone. And so, honestly, one of the things that would help keep me happy and healthy is for more people to get their COVID vaccine so I can see less of those kinds of cases that we're seeing and see more of the enjoyable, well, child preventive care type work that that I really thrive on. And that is very enjoyable to me.

Erin Spain, MS [00:16:38] Well, that is a great note to end this conversation. Thank you so much, Dr. Terrence Steyer, for all of your information today. I hope that some folks listening will reach out to you. And if they haven't gotten that vaccine yet, they'll come and get it.

Terrence Steyer, M.D. [00:16:51] I hope so. And MUSC primary care is here for you and for your health care needs. And we'd be happy to take care of anyone who needs that. We're fortunate that we have locations throughout the county. So, you don't have to come to the peninsula to get your health care. You can be in Summerville or West Ashley or Mount Pleasant and see an MRI, see primary care provider in your own neighborhood.

Erin Spain, MS [00:17:13] For more information on this podcast, check out advance.muschealth.org.