Published on June 09, 2021

Are You Missing Something?

Doctors Speak Out Urging Patients to Close Gaps in Essential Care

Among the consequences of the pandemic is that many Americans have fallen sorely behind in preventive care, with underserved

David Jordahl, M.D.David Jordahl, M.D.
Family Medicine
MidMichigan Health Park – Bay 

groups disproportionately impacted. Now that hospitals and doctors’ offices are open for business and have strict safety protocols in place, providers are urging patients to get caught up on essential tests and procedures that can prevent serious complications or even death.

A survey released by the Prevent Cancer Foundation last August found that 43 percent of American adults had missed routine medical appointments, 35 percent of adults had missed a scheduled cancer screening, and 17 percent of parents had missed a scheduled vaccination for one or more of their children because of COVID. Twenty-two percent of those who missed appointments said their doctor’s or dentist’s office was open, but they wanted to minimize their risk for COVID-19.

On April 16, the Healthcare Cost Institute (HCCI) published an analysis of insurance claims showing that childhood immunizations declined by about 18 percent for the year 2020 compared to 2019, and that screening colonoscopies, screening mammograms and screening pap smears were down by 27 percent, 19 percent and 13 percent respectively.

Epic Health Research Network reported in February that weekly emergency department visits dropped as low as 50 percent of predicted visit volume during the early months of the pandemic and have since only recovered to approximately 75 percent of predicted volume. In addition, patients presented with higher acuity problems that resulted in higher hospital admission rates and greater risk of serious harm or death.

The Centers for Disease control also reported in February that in the first six months of 2020, life expectancy in the United States fell on average by one year. Mortality statistics varied widely across demographic groups. Last year, excess deaths increased 14.7 percent for white people compared to 44.9 percent for Latino and 28.1 percent for Black populations, according to the CDC.

All these data point to a disturbing trend: patients are missing out on essential care that could minimize complications and ensure better outcomes. Worse, the same groups who have already experienced greater impacts from COVID-19 are more likely to have conditions like hypertension and diabetes that could lead to serious consequences if undetected or untreated. These groups are also less likely to have timely and affordable access to preventive care.

Primary care providers at MidMichigan Health are joining with their colleagues across the nation to raise awareness of this issue and to urge their patients to take action.

“While patients may regard routine visits, lab work and screenings as ‘elective’ or non-urgent, we consider them the cornerstone of excellent care,” said David Jordahl, M.D., a family medicine physician and director at MidMichigan Health Park – Bay. “These tests can mean the difference between detecting conditions early while the prognosis is still good and we have many options for treatment versus possibly even having to deliver the bad news that there is little we can do at this stage.”

Dr. Jordahl notes that advances in electronic medical records make it easier than ever to track and report to patients whether they are up to date on recommended screenings. He suggests that patients log into their secure patient portal or contact their provider’s office to see if they are overdue for any critical tests, and that they act promptly to schedule an appointment if their doctor’s office, insurance company or care manager reaches out to notify them of an overdue procedure.

In particular, he recommends that patients place a high priority on screenings for cancer, diabetes, hypertension, heart and vascular conditions and any other chronic conditions that they are actively managing with their care team. These tests are listed in the table for easy reference.

“We recognize that some patients may still be apprehensive about venturing out during the pandemic. We want to ensure them that we can safely care for them and to remind them that being proactive can avoid situations that are as bad or worse than COVID,” Dr. Jordahl said. “We also want our patients to know that we are here to help them identify solutions if other factors, such as affordability or access to transportation, are preventing them from seeking care.”

Prioritized Recommendations for Essential Care

While this is not a comprehensive list of all recommended care, these high priority items require more frequent attention. If you’ve fallen behind, now is the time to get caught up before a serious health issue arises. The listed screening recommendations are based on average risk. Your doctor may also prioritize additional care based on your personal health history and risk factors.


  • BMI assessment for obesity screening
  • Blood pressure screening
  • Cholesterol screening
  • Diabetes screening
  • Vaccinations (keep up to date with recommended schedule, including COVID-19)
  • Depression screening
  • Cervical cancer screening starting at age 21, every 3 years until age 30, then every 3-5 years until age 65
  • Breast cancer screening with yearly mammogram starting at age 40
  • Colon cancer screening starting at age 45 (frequency depends on method for screening)Dental exam every 6 months
  • Follow-up testing and treatment as recommended for any diagnosed conditions


  • Well-child visits (12 visits by age 3 then annualy thereafter)
  • Vaccinations (keep up to date with recommended schedule)
  • Growth metrics at every well-child visit
  • Vision/hearing screening
  • Behavioral/developmental screenings at every well-child visit
  • Depression screening starting at age 12
  • Oral health assessment by primary care provider starting at 6 months of age
  • Follow-up testing and treatment as recommend for any diagnosed conditions


Prevent Cancer Foundation, “Prevent Cancer Foundation Announces ‘Back on the Books’— A lifesaving initiative in the face of COVID-19," August 6, 2020,

Martin et al, “The Impact of COVID-19 on the Use of Preventive Health Care, April 16, 2021,

Noel et al, “Fewer Visits, Sicker Patients: The Changing Character of Emergency Department Visits During the COVID-19 Pandemic”, February 3, 2021,

Arias, et al, “Provisional Life Expectancy Estimates for January through June, 2020”, National Vital Statistics Rapid Release Report No. 010, February 2021,