ZACH MOORE: Welcome to On Health<i> </i>with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

PAIGE ROMANOWSKI: My name is Paige Romanowski, and I'm a media relations specialist here at Houston Methodist.

ZACH: And Paige, how often do you go to the doctor for a checkup?

PAIGE: As somebody a part of the Gen Z group, I think I'm in the minority. Well, I know I'm in the minority. I do do an annual checkup. However, according to a recent study conducted by Ohio State University's Wexner Medical Center, a quarter of Gen Z actually does not have a primary care provider or just forgoes going to the doctor annually.

ZACH: Wow. Now, I'm still in my 30s, barely, and I can relate to that because in my 20s, I did not have a primary care physician. And before I worked here, honestly, working here at Houston Methodist, it really does help to work in a hospital to get you in those regular appointments, right?

PAIGE: Right. I mean, it can seem kind of intimidating. You're coming off of your parents' health insurance, and you're like, "Oh, what is this gonna cost me? How do I know if I found a good doctor? Do I actually have to call to make an appointment, or can I do this online?" So it definitely can be intimidating, but it's a staggeringly low number.

ZACH: Yeah. There's the financial situation. There's just the uncertainty of, "Well, these are personal things, right? I don't want to talk to some stranger about it. So I'd just rather, in the comfort of my own home behind my keyboard, look these things up." And that's not necessarily gonna give you the answers you need, right?

PAIGE: Right. I mean, Gen Z in particular, as a member of it myself, I have definitely fallen victim to the wearables and checking my scores and overanalyzing what that means, and then either avoiding making an appointment to address my concerns. And with such a large portion of young adults not visiting a doctor routinely, a lot of people are missing out on those crucial vaccinations and crucial screenings, flu shots, tetanus shots, all of that stuff that are pretty baseline healthcare vaccinations here are going missed by this giant portion of young adults.

ZACH: Yeah. You talk about vaccinations like the tetanus shot, right? Unless you get a new job, when's the last time you think about, "Oh, I better get a tetanus shot?" Well, you better, right? Because who knows what might happen.

PAIGE: Rusty nails are everywhere.

ZACH: Right. Exactly, right. A lot of these shots are preventative because you never know when you're gonna step on a rusty nail or something like that. Look, the information's out there, but I think when you don't have to do it, when you're... I mean, that's this age range, right? You're not a kid anymore.

PAIGE: Right.

ZACH: You're living on your own. Your parents aren't driving you to the doctor like they used to, right?

PAIGE: You feel healthy. You feel fine.

ZACH: Like, "I'm great," right? "There's no problem," right? "Do I need a flu shot? I don't know." Right, so then you just don't get one and then you turn around it's been ten years and when was the last time you got a flu shot? And then, you know. So that's what we're talking about today, health screenings. You should not skip, especially if you're in your 20s and 30s. And who did we talk to about this, Paige?

PAIGE: We're talking to Dr. Seva Papageorge, and she is one of our primary care physicians here at Houston Methodist. And she's here to help you on your health journey from 18 to 30 to beyond. We're gonna be talking about something that's very natural to you, something that you do every single day. But we're gonna talk about something a lot of people in their 20s and 30s tend to put off, which is health screenings. You feel busy, you feel okay, life kind of gets in the way. But when you see patients in their 20s and 30s, what are the biggest screenings to check for and that you don't want them missing, even if they look and feel completely healthy?

DR. SEVA PAPAGEORGE: Thanks for asking. Well, right away, when you first walk in for your preventative care checkup, we check your vital signs. I wanna know what's your heart rate, what's your blood pressure, what's your weight and your height. That's gonna give us a lot of information. Definitely never wanna miss those once a year, even if you're healthy. It's important to go for your preventative check once a year to your doctor. And the next thing we look at after that is we start asking a lot of questions.

PAIGE: Definitely. And what are some indicators from these vital signs that might not be always apparent to the patient that you want to bring up to discuss?

DR. PAPAGEORGE: Well, part of it is, is your heart rate high? Why is it high? Patients in their 20s and 30s should have a normal heart rate. And the silent killer, of course, that we all talk about is elevated blood pressure. I wanna know your blood pressure is normal. You could feel great for 10 years and have an elevated blood pressure. And we know with elevated blood pressure, even if it's a little bit high, over decades, it does cause some damage that could have been preventable.

PAIGE: Right. Definitely. And so, you mentioned going in once a year around this timeframe in somebody's life. What would be an indication that they should maybe stop by more frequently?

DR. PAPAGEORGE: Well, at your preventative care checkup, we're gonna find out a lot of information of do you need to come in more often? Is there something we need to manage a little closer, check more items? If you're having symptoms, if you're having headaches and you don't have a reason to have headaches, then absolutely get in. If you've noticed your heart rate is elevated and not just with exercise, then yeah, you need to come in and get checked.

PAIGE: Definitely. Not something we wanna play around with.

DR. PAPAGEORGE: Not at all.

PAIGE: Which screenings often catch the most common silent killers or issues in this age group before they really notice?

DR. PAPAGEORGE: So definitely blood pressure, heart rate. That can tell us a lot. And when a patient comes in for a preventative checkup, I usually do blood tests on them. I wanna screen their sugar. I wanna check their cholesterol. Some people have high cholesterol and it's not what they're eating. It's not what they're doing. It's genetic. And I'd like to know from the beginning so we can prevent any plaque buildup.

PAIGE: Definitely. And with those folks who do have something genetic going on rather than exercise or dietary, how do you approach that conversation with them? I can imagine it's pretty scary when you're so young.

DR. PAPAGEORGE: I'm sure it is scary for them, but the most important thing is this is treatable and we don't want them to have issues later on. I wanna see them in 40 years and they're complaining about something and they've got blood to their brain and blood to their kidneys. And I think that's what they're more afraid of. It's not a medication. It's really, "What could happen to me if I don't treat this."

PAIGE: So kind of going off of genetics, how much does a family history really impact one's health, especially early?

DR. PAPAGEORGE: It actually impacts it a lot. Certain kinds of cancer that somebody's relative, parents, grandparents may have had at a younger age, then we know we need to look a little closer for our patient, make sure we're screening them. Cholesterol, of course, high blood pressure. Those are some of the big ones that we wanna look at. Metabolic issues, people with high sugars.

PAIGE: Yeah, that's great to know. It is kind of crazy to think about when you're so young that already you might be seeing implications of that. But it's great to know that physicians are really taking into account that background. What key screenings do you recommend for women versus men?

DR. PAPAGEORGE: So for my male patients, we have to look at what's the difference between men and women. So for my male patients in their 20s and 30s, I still recommend testicular exams. Most of my male patients by the time they're in their 20s, they know their testicles. Someone has taught them a testicular exam. If they have never been taught it, I'll teach it to them. And I tell them to look for -- what to look for and what to be aware of, because part of it, they just don't wanna talk about it. But once they know, all you have to do is message me if you find anything new or unusual. It gives them a little confidence to take care of themselves. That's really important for my male patients. For my female patients, of course, cervical cancer smears. We start after the age of 21 if they've had any sexual touch in their lifetime.

PAIGE: Awesome. That's great to know that the preventative care is really first and foremost at this point in time. And for patients who do notice something a little bit different or unusual, what is the best way to contact their physician?

DR. PAPAGEORGE: You message your physician through MyChart or you make an appointment. Sometimes even a message, the doctor will say, "Please come in. Let's talk about it." Sometimes a patient will message me and I'll say, "Okay, I'm ordering your ultrasound. I'm sending you to the specialist. Let's make sure we get on this right away and that you're okay."

PAIGE: Definitely. So would you consider family medicine kind of that gateway to receiving specialty care?

DR. PAPAGEORGE: Absolutely. I know my patients really well. I know their families. They come in, they chat. And I think once you get that relationship and you're comfortable with your doctor, you're not as afraid.

PAIGE: Right. Again, just being so young in 20s and 30s, a lot of people at this age haven't been exposed to being in a medical system or even necessarily what specialty care even means. So it's great that you serve both as their physician but as an advocate for them as well.

DR. PAPAGEORGE: And that's my job. Their job is not to suddenly go to medical school and know what's important and what's not important. I always tell them, "Just make an appointment. Come in. Let's talk about it. I'll tell you what really is important we need to look out for and what we need to do something about. And I'll let you know if it's something you don't need to worry about anymore. But sitting around worrying about it is not good for your health, mind, body, or soul."

PAIGE: So looking at the era of health anxiety that people are in, I personally have noticed more people on social media talking about it ever since COVID. Have you seen an increase in health anxiety in younger adults?

DR. PAPAGEORGE: Absolutely. And I always tell my patients, "If you read it on social media, first look at, why did someone write about this? What are they gaining from it? Are they trying to sell me a supplement that I really don't need and may cause me harm? Or is this something I need to be aware of?" If you come into your doctor once a year, they'll screen you every year for what you need. And it's what you need, not what is the standard for everyone. Because like we said, some people have different family histories. Some people have different vital signs. Some people do different things with their body. And I wanna know, "How much are you drinking?" when we're talking about alcohol. "Are you using nicotine products? Any drugs that you use?" Are you using supplements that I need to look out for and check?"

PAIGE: Sure. And I bet it is interesting to get kind of that full profile of a patient, because it isn't always easy to talk about, "Oh, sure, you know, I'll have a drink socially" or when that might be something more. When you do have a patient who comes in with something that might be more, what steps do you take to help them get sort of back on the track to health?

DR. PAPAGEORGE: Well, if we're talking about nicotine or tobacco, we talk about, "Are you ready to slow down? Do you know it's an issue? Can I explain to you why? Can I offer you medication or patches or therapy or anything I can offer to help?" And sometimes they're ready and they've been waiting for someone to ask them and someone to help them. And sometimes they're not. My job is to keep asking and keep trying and keep offering and make that door open. Alcohol, same kind of thing. I'm gonna check your liver enzymes. If they're elevated from alcohol intake, we're absolutely gonna slow down our alcohol and repeat it.

PAIGE: Definitely. It's great to know that, again, your primary physician is there to help you and not judge you or shame you for what kind of position you may or may not be in, whether you realize you're there or not.

DR. PAPAGEORGE: Not at all. No judging. And I think that's what makes me sad is when some people are afraid to go to the doctor because they're afraid of what they're gonna say. They don't wanna be judged. No one wants to be judged. And that's not my job. My job is to offer you everything in medical technology to make your life better for today, for tomorrow, for 40 years from now.

PAIGE: And I'm sure that that provides patients such peace of mind when going in and makes it a little bit easier to be open about their health history.

DR. PAPAGEORGE: I hope so. I hope so. I know it's scary to go to the doctor. It's -- when you're a kid and you go to the doctor, you're always getting a shot and it hurts. So they walk in and I know what they're thinking. They're thinking, "Don't hurt me."

PAIGE: Right.

DR. PAPAGEORGE: "Don't embarrass me in the exam and say, 'You shouldn't have done that. Why are you doing this?' And don't find anything wrong with me." Those are normal thoughts. That's why people are apprehensive when they walk in. And when a patient says, "I'm a little nervous," I'm like, "You should be, that's very normal."

PAIGE: Do you ever see that nervousness show up in any of their screenings, like blood pressure or heart rate?

DR. PAPAGEORGE: Oh, absolutely. Absolutely. They'll -- Like I said, you walk in the door the first thing we do is we check your vitals. After I've been with my patient for 10, 15 minutes, I usually have to recheck their blood pressure again. And it's much better. I would say about 80% of my patients, I have to recheck it manually after they've had a chance to just sit and take a breath.

PAIGE: Wow. I'm so glad that you're able to recheck that just to ensure that, "Hey, you were just feeling a little bit nervous coming in today. There's nothing wrong."

DR. PAPAGEORGE: And it's my job. I need to know you're okay.

PAIGE: Definitely. Health feels oftentimes like something we worry about later in life. So for the patient in their 20s and 30s, who may have a diagnosis that they weren't expecting, how do you guide them through that process?

DR. PAPAGEORGE: Well, first, honesty. We have to diagnose the problem and I have to tell them absolutely what we're looking at, what my thoughts are, what my concerns are. And then usually if it's something serious, I've already got an appointment with a specialist set up because the last thing they need to hear is, "Hey, I think you have cancer." And then I leave them alone.

PAIGE: Right.

DR. PAPAGEORGE: If it's elevated blood pressure, "Is it something we need to treat with changing your diet, lowering the salt, increasing the exercise, or is this something that needs medicine?" And I'd much rather they take a pill every day and live forever than have an issue just because we were afraid of a pill.

PAIGE: Right.

DR. PAPAGEORGE: So part of it is what the condition is. Is it something I can treat? Is it something they just need to change in their lifestyle? Or is this something we need to hire a specialist for?

PAIGE: Definitely. And looking at the busy lifestyle of people in their 20s and 30s, is the annual exam really the best way to get the most bang for your buck, the most ways to make sure everything's going all right and get your screenings done? Or is there another way that people should consider?

DR. PAPAGEORGE: Absolutely. Come in. I only have 15 minutes per patient. So you're not gonna be here that long. And we can talk about everything we need to talk about. And it is just preventative. If you have back pain, if you have unusual headaches, make an appointment just for that. But this is your preventative checkup once a year. And most Methodist clinics have a lab either in the office or in the building. So if we're doing blood tests, we'll send you straight there and you can get that done. So they're pretty simple, pretty quick, usually not too painful at all.

PAIGE: What is one red flag or symptom people in this age group tend to dismiss that maybe they shouldn't?

DR. PAPAGEORGE: Change in their bowel habits, bowel movements.

PAIGE: Sure.

DR. PAPAGEORGE: Blood in the stool. That is one that I always wanna make sure people are able to ask about and talk about and know to come in for and not to wait. If they have chest pain with exercise, absolutely come in. That's different.

PAIGE: Right. Well, that is so great. And how do you approach these conversations with these younger patients as they might not be so forthcoming with topics like bowel movements?

DR. PAPAGEORGE: That's my job. I absolutely just ask. And I know some people giggle and they get a little nervous when I talk about poop. But I talk about it every day, all day long. It's no big deal.

PAIGE: It's an important function.

DR. PAPAGEORGE: It's an important function. And I think just making it, like you said, nonjudgmental, just part of life. We talk about it all day long. It helps them and go, "Okay, this is normal. I need to talk about this. It's okay."

PAIGE: Right. Kind of de-stigmatizing that, making it a little bit easier to talk about. And what is one piece of advice that you would give any patient in their 20s or 30s who is nervous to go to the doctor or has been putting it off?

DR. PAPAGEORGE: Well, first, go. Make that appointment. I know it's hard, but make that appointment. Go in. Meet the doctor. If you absolutely don't get along well with the doctor, it's okay. We live in a huge city with lots of doctors to find someone that you feel comfortable with. And it's also okay to tell your doctor, "I'm really nervous to be here." And also tell them what you're nervous about. If it's a specific thing, then your doctor can address it. They can check it out and make sure we're doing everything we can, like we said, to prevent further issues later on in life.

PAIGE: Yeah. That's great to know that we truly are a connected team, just working to make sure that everybody gets the care that they need. Well, thank you so much for joining us on the podcast today, Dr. Papageorge.

DR. PAPAGEORGE: Thank you so much for having me. I really appreciate you taking the time to talk about something so important and something that could be so easily done.

ZACH: So Paige, as a Gen Z-er yourself, you related to this topic of conversation?

PAIGE: Definitely.

ZACH: Yeah.

PAIGE: I mean, I'm as guilty as the next person, even working in health care. Either just booking my annual and not really following up or letting it slip a year.

ZACH: Mm-hmm.

PAIGE: So I just think it's really great for everybody who's in their early adulthood to just take a look at when's the last time you went to the doctor? When's the last time you got a flu shot?

ZACH: Yeah.

PAIGE: All of those preventative medicine opportunities are really essential to making sure that you stay healthy throughout your life. And if something is going on, you can catch it early.

ZACH: Yeah, absolutely. And look, like anything, the longer you wait, the longer you're probably gonna wait. Because there's just like, you're like, "Oh, I don't know. It's been so long." There's no shame. If you haven't been in 10 years, it doesn't matter. Start going now, right? There's no reason to say like, "Well," or even conversely, like, "Well, I've gone this long. I don't need to go." I'm like, "Well, you're playing with fire right there," right?

PAIGE: Right, yeah. There's no shame at all. No matter how long it's been, they're just happy to help you out. Happy to see you in the office. Gen Z is really one of those generations that is so hyper-focused on health and wellness and the perfect morning routine.

ZACH: Yeah.

PAIGE: And I'll be the first to say it. [Laughing] You should probably book a doctor's appointment just to make sure everything's okay too.

ZACH: There you go. All right. Well, that's gonna do it for us this time on<i> </i>On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So until next time, stay tuned and stay healthy.