Screening: Looking for Something Wrong when Nothing Is Wrong
Shenary J. Cotter, MD • January 22, 2020

The most common reason that people come to the physician is that something is wrong. Often, it is due to symptoms that have either not responded to normal over-the-counter medications and "tincture of time," or it is due to the patient being concerned that it is more serious than the troublesome but largely benign viral illness or rash. 

One of the most IMPORTANT reasons to establish with, and come in to see, your physician is for health screening. A screening test or evaluation is something that is done to look for a problem when there are no symptoms or signs of the problem. An example would be a screening mammogram, or a colonoscopy for someone who has reached the age of 50. The goal of these tests is to either catch a disease early, and thus decrease the harm it may cause (such as cancer), or to prevent disease altogether (such as with checking lipid panels to prevent heart disease).

Over the years, physicians have come up with many different hopeful screening tests, but some have not stood the test of time. Others have been adapted as data on their effectiveness has made it more clear. Recommendations change depending on new evidence. An example of the latter is the PAP smear, which screens for cervical cancer. Previously done yearly, it is now done with or without high-risk HPV screening at either 3 year or 5 year intervals. 

An excellent source for what screening tests are indicated is the United States Preventive Services Task Force. Their recommendations take into account the quality of evidence that supports the screening test. 

In our direct primary care practice, we have found an increased effectiveness in using the screening recommendations for our patients because we have time to get an excellent family and personal history. We also have time to explain the data behind the screening recommendations. This allows for what is called "shared decision-making" discussions that are meaningful. In shared decision - making discussions, we are interested in finding out what the patient cares about, and not just recommending things according to guidelines.

U.S. Preventive Services Task Force

If you would like to find out more about how we are better able to provide screening testing that complies with guidelines AND with shared decision-making discussions, please call to set up your free meet-n-greet with one of our physicians. The number is (352)204-0120.

Family Medicine Holistic Covid Consideration

By Shenary J. Cotter, MD • November 15, 2020
Wow! What a title! It packs a LOT into a few words. When a family physician, a primary care physician, has to consider how to advise a patient, this is going to include what is called "shared decision making." And never has this been more relevant than during the current times. As we head into Thanksgiving and Christmas, with the Heartland of our nation facing unprecedented sickness and deaths from COVID 19, we ALL must make difficult decisions about personal safety, but also that safety of t

Primary Care PTSD

By Shenary J. Cotter, MD • February 9, 2020
This is a confession. It's not pretty. But it happened and reminded me of my commitment to justice in medicine. My partner, Althea Tyndall-Smith MD, and I left employed positions as Family Medicine physicians in order to practice medicine in a manner that honored ourselves as physicians, as wives and mothers, and that honored our patients just as much. We stepped off "the treadmill" of frantic running from room to room, documenting enough "bullets" on our EHR notes to make sure and capture al

Coronavirus: Should You Be Concerned?

By Shenary J. Cotter, MD • January 29, 2020
Coronavirus, named by the CDC 2019-NCoV, has arrived in the United States. Reports of severe illness, hospitalization, and death have prompted many questions about the risk to ourselves and our families here in Gainesville, Florida. When faced with questions regarding communicable diseases, the best source of information that I have found is the Center for Disease Control website: CDC.gov. It is CRUCIAL that objective, scientific sources be sought instead of second or third (or fourth or fift

Why a Physician?

By Shenary J. Cotter, MD • November 5, 2019
Gainesville Direct Primary Care Physicians currently offers patients a choice between Althea Tyndall-Smith, MD, and Shenary Cotter, MD. Both physicians graduated from accredited schools of medicine, and completed three year residencies in Family Medicine. In addition to completing residency, multiple arduous and comprehensive tests were successfully completed in order to get into medical school, pass from the second year to the third year of medical school, pass each clinical rotation during m

Open Enrollment - Time to Make a Change to Direct Primary Care!

By Shenary J. Cotter, MD • September 4, 2019
Fall is the Season of Pumpkin Spice, Gator Games, and .....open enrollment. This is a GREAT TIME to decrease your commercial insurance plan coverage (which will make your plan less expensive), and add a membership with Gainesville Direct Primary Care Physicians. The money saved by doing this, even with the added membership, most often results in a net savings for the member or family. Let's look at this more closely! First, what exactly is "open enrollment," and why does it exist? Health Insu

Direct Primary Care.....and automobiles? huh?

By Shenary J. Cotter, MD • August 14, 2019
OK, hang with me here. We are going to start with an analogy. Imagine that every issue related to your car was subject to the question, "does my auto policy cover that?" Yes, collisions and accidents, absolutely. But what about cleaning the fuel injector? Periodic oil changes? Replacing the tires as they normally wear out, with age and use? What about cleaning the carpet, or repairing upholstery tears? Periodic "check ups" and "diagnostics?" If your auto policy "covered" these things, what

What's a Board, and what does it certify?

By Shenary J. Cotter, MD • August 8, 2019
Gainesville Direct Primary Care Physicians proudly promotes the Board Certification status of myself and my partner, Althea Tyndall-Smith MD. But what does this mean, and why should you care? For physicians, Board Certification is a designation that requires three steps. The first two steps take a minimum of 11 years, and include a four year bachelor degree, four years of medical school, and a residency (apprenticeship training) of at least 3 years. The last step is an ongoing process that c

Feeling Healthy?

By Shenary J. Cotter, MD • August 7, 2019
It is a fantastic feeling - that vibrant sense of wellbeing when we are making all the right choices and effort, and we are seeing, and feeling the results. But "healthy" is more than what we are feeling. A rough night sleep, a car that won't start, a difficult interaction with someone at work - these are all experiences than result in feelings that try to lie to us. The lie says that we are failing, that we can't succeed, that trying is too hard, and that our efforts can't matter. The TRUTH
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