The key to avoiding health problems is prevention, and the keys to prevention are annual checkups, regular screenings and vaccinations. With the start of the next school year looming in late summer, healthcare experts in Atlanta say it’s a good time for families to get back into the routine of scheduling and keeping these important appointments — not just for children, but for parents too, especially that one parent who tends to be the primary scheduler, often the mother.

In an Atlanta Business Chronicle panel discussion in partnership with Wellstar, physicians from Wellstar and Cobb & Douglas Health District discuss why checkups are important and how families can overcome obstacles to stay on track with preventative care.

Taking care of the family and the family’s No. 1 manager

David Rubinger, Atlanta Business Chronicle market president and publisher: When we think about family wellness and how it intersects with our daily work routines, it can get very complicated, given how busy working professionals are. We’re trying to figure out a way to manage not only our children’s health, and maybe our parents’ health if we’re in the sandwich generation, but our own health. The checklist is longer and longer every day. Let’s start with the basics. We’re a few weeks away from the start of school. Dr. Stinson, what are you telling your parents of kids of school age right now?

Dr. Carrie Stinson, chief, Pediatric Service Line, Wellstar: The summer is a great time to get caught up on all the things that fall through the cracks during the busy school year. Our lives are very hectic, and when school starts back, things get even busier.

One big thing is the annual well-child exam. Every child should have a well-child exam every single year. When you have babies and toddlers, it’s routine — you’re scheduling these frequently. When kids get older and busier, these visits may feel less important and fall off your radar.

Well visits are important every year. They focus on the comprehensive health and well-being of your child. Pediatricians focus on physical health, development, emotional, social, and even behavioral health. During these visits, the care team collects information on patient and family history, talks about developmental milestones and how your child is doing in school socially. We also assess sleep habits and nutrition. As they become adolescents, well-child exams become even more important as we ask questions about your child’s mental and sexual health.

Those are important conversations to start having and your pediatrician can be a great facilitator. Sometimes parents are uncomfortable talking about those topics with their children even at an early, pre-adolescent stage, so those well checkups are really great places to get insight on how to approach sensitive topics.

Rubinger: Dr. Stinson, since Covid, tell me what you’re seeing that’s different in terms of talking to both parents and children. I am sure the pandemic took some families off their schedules for well checkups. How has the doctor-patient pediatric conversation changed over the past couple of years?

Stinson: What we’re hearing from our pediatricians since Covid is also what we’re hearing in the news. The behavioral and mental health crisis that we’re experiencing in this country has been really impactful on children, especially teenagers. During Covid, the social isolation of being out of school for periods of time had a significant impact on adolescents. The rise in social media popularity during that time also had a negative impact on pediatric mental health.

Our pediatricians are really seeing that impact now. They’re feeling the strain our teenagers are experiencing. We’re seeing many more cases of depression and anxiety, and cases that escalate to dangerous proportions such as suicidal thoughts and actions.

We’re trying to respond to it by increasing the resources in our communities, but it’s hard to move fast enough to keep up with the demand. At Wellstar, we are developing an integrative model for behavioral health into our pediatric offices. Five of our pediatric practices will have embedded behavioral health professionals, so pediatricians can make direct referrals and patients have immediate access to behavioral health providers in their pediatric office setting.

Rubinger: Dr. Greaves, the mother might be the caretaker who takes care of the child. Most mothers would put their kid’s health ahead of their own health. Tell me what you are experiencing in terms of women’s health as it relates to those people who are the caretakers. What are the issues that they’re having to face to address their own needs?

Dr. Paula Greaves, chief, Women’s Health Service Line, Wellstar: Women are usually considered the CEOs of their households and the drivers of healthcare in the community. Most women are the care bridge between several generations. They take care of their children, their parents, their partners and at times their communities.

Unfortunately, they sometimes forget to take care of themselves. As physicians, it is our duty to ensure that women are made aware of the warning signs their bodies may be sending them and encourage them to seek help earlier to improve health outcomes.

There are nine signs that I tell my patients to watch out for:

Fatigue: Most women think, “Oh, I’m tired. It’s because I’m doing too much or I’m not getting enough sleep.” But fatigue can be a sign of something more than simply lack of sleep. It could be thyroid dysfunction. It could be menstrual irregularities causing them to be anemic and thus feeling fatigued. It could be heart disease. Fatigue could also be a sign of depression or menopausal symptoms. Every household should own a blood pressure monitor, and women should know their numbers (blood pressure, weight, and last menstrual period).

Women should be aware of physical changes within their bodies, including breast changes. Changes in the texture of the skin or a lump or pain in the breast should always be checked out.

Bloating is another subtle symptom to be aware of. Most women feel bloated and think, “Oh, it’s time for my menstrual cycle, so that’s why I am bloated.” But bloating can be a sign of a gastrointestinal problem or an enlarged pelvic organ. If you have bloating that doesn’t resolve after one or two cycles, let your doctor know.

Chest discomfort, shortness of breath, and pain or discomfort in the jaw, neck, shoulder, or arm are also red flags. Heart attack signs and symptoms can be completely different in women than the typical ones seen in men. Heart disease is the number one killer of women, so it is very important that these signs are not ignored.

Lung cancer isn’t just a smoker’s disease. If you notice an unusual cough or wheezing, have it checked out.

Weight changes: Either too much weight gain or unexpected weight loss should be mentioned to your physician. Fluid retention can also affect weight gain.

Blood in the urine or stool should be reported.

Irregular or heavy periods — heavy enough to change pads every hour or soil through clothes.

Skin changes such as discolorations, new moles or growths are definitely worth having a professional take a look.

Rubinger: Is there ever a situation, Dr. Stinson, where you are treating a child and you see a mother whom you can tell is having health issues, even without an exam? As a pediatrician, do you ever say, “Hey, I think you need to get that checked out?”

Stinson: As pediatricians, we really focus on the whole family. While we’re seeing the child, we’re also interacting with the parents, guardians, grandparents, or whoever’s bringing the child in to see us on a routine basis.

I think we often get questions from family members about their own health because of exactly what Dr. Greaves mentioned. People think, “I am in a doctor’s office. I don’t have time to go to my own doctor. Let me just see if I can get this question answered.”

While being careful not to give medical advice to a patient who is not ours or who is outside of our scope of practice as pediatricians, we are very willing to give recommendations on where that person should seek care. One benefit of our health system is we have the expertise to take care of patients from before they’re born until they need end-of-life care. We have a scope of providers within our system who can help with pretty much any problem that might come up. I would not hesitate to refer a patient to Dr. Greaves and say, “This mom is really worried about her own health. Can you please help? She’s very busy, but her symptoms sound concerning. Can you maybe work her into your schedule?”

I practice in the hospital, and we have sent several parents to the emergency room in our hospital for their own health while we’re taking care of their child in the pediatric unit.

How providers are addressing rising mental health needs

Rubinger: Dr. Memark, you get to look at this from the standpoint of two counties that are in great need of public health support. What are the trends that you’re seeing at a 30,000-foot view? What do you see within your communities that your organization tries to address?

Dr. Janet Memark, district health director, Cobb & Douglas Health District: From my point of view, one of the big things that we do at Cobb & Douglas Public Health is a large community health assessment. Dr. Greaves is actually a member of our board. We just finished a 2016-2020 five-year assessment. This was at the beginning of the pandemic, so keep that in mind. Our next assessment will capture 2021-2025. One of the things that was surprising to me was looking at causes of death in our communities. The assessment showed that in older people, it’s what you’d expect. For example, in Cobb County for those age 75 and older, the leading causes of death are things like vascular disease, stroke and Alzheimer’s. For ages 65 to 74, it’s heart disease and cancer. But when we started looking at the lower age groups, I was very surprised at what I saw:

For people in their 30s and 40s, the leading cause of death was accidental poisonings, and that includes drug abuse and drug overdoses. Number two was suicide.

For ages 25 to 34, number one was overdoses and poisonings and number two was suicide.

For ages 20 to 24, motor vehicle accidents were number one. Suicide was also number two for this group.

For 15 to 19, suicide took the number one spot. Number two was motor vehicle accidents.

For 10 to 14, number one was motor vehicle accidents followed by suicide.

After the timeframe studied in the assessment, we went through two more years of the pandemic, which affected almost everyone’s mental health in one way or another. We’ve heard on the news how pediatricians in medical school are now being trained on how to provide more extensive mental healthcare because there just aren’t enough mental health experts.

It’s wonderful to hear Dr. Stinson say they are really trying to bolster up mental health screenings for our young people during their pediatric visits. I’d also like to add that we have high rates of maternal mortality in Georgia. The state Department of Public Health did a deep dive and found that mental health is a huge component of maternal mortality. You see these same themes of mental health running through several different medical specialties.

Rubinger: Dr. Stinson, when you came out of medical school, I’m sure you had a psychiatry rotation. Are medical professionals getting enough mental health continuing education? Do we need a larger mental health evaluation component? Because clearly it’s a problem and it’s always been there. But it seems to have gotten worse. How do we address that?

Stinson: Yes, I took a psychiatry rotation in medical school, just like everyone does in pediatric residency. We get a very small amount of exposure, but I hope that is increasing now.

Pediatricians in the community are learning on the job. There are many CME (continuing medical education) opportunities that pediatricians are taking advantage of in order to learn more and train ourselves because we want to take better care of our patients. The behavioral health crisis has also made it more difficult to recruit new pediatric providers. We are very clear that pediatricians must be comfortable seeing some degree of mental health concerns. And there are some pediatricians who say, “I’m not comfortable with that,” and we have to say, “this isn’t going to work out because it’s not going to serve our patient population well.” We’ve had applicants come back and say, “I’m going to do some CME and educate myself and come in with resources of my own.”

And we’re asking for resources in our health system, just like others in Atlanta and across the state. We realize that it’s a problem that doesn’t exist in any one bucket. It is a pervasive, system-wide issue that impacts every geographic location. It impacts every specialty: pediatrics, women’s health, adult internal medicine, surgery and other specialties.

Patients with other comorbidities are at higher risk for mental health issues, so everyone must come together to support initiatives that allow for an increase in resources. It’s hard because financially for healthcare systems, it’s not always the most attractive thing to invest in. You have to believe in the mission behind it and what we’re doing for the community and for our patients.

Rubinger: Dr. Greaves, do you want to address this issue?

Greaves: The United States is in the midst of a maternal health crisis. The U.S. has the worst rate of maternal mortality of all the developed countries, and Georgia has one of the worst rates of maternal mortality in the U.S. Up until last year, we always quoted that the number one contributing factor to maternal mortality was cardiovascular disease. However, recently it has been confirmed that maternal mental health issues and substance use disorders are some of the main contributing factors to America’s high maternal mortality rates. These include drug overdoses, postpartum depression, suicide, and domestic violence leading to homicide.

I am very grateful to be part of the community along with Dr. Memark and Dr. Stinson and the work they have done to address this mental health issue. As a health system, Wellstar’s behavioral health service line has made great strides to penetrate every service line with a collaboration or intersection with behavioral health: GI, cardiology, oncology, pediatrics, and women’s health, among others.

Postpartum depression extends beyond the six-week post-partum period. We must follow our patients for at least up to one year after delivery, to ensure wellness.

I am grateful for the collaborative relationship with pediatricians, who often observe moms with babies during the infant well-check exams. Our pediatrician partners may call to alert us regarding concerns about mom’s well-being.

We also utilize various national organizations; one of them is called PSI — Postpartum Support International — to train physicians and staff to be advocates and provide support for post-partum women.

The role of vaccinations in family and population health

Rubinger: Let me move on to another topic because I think we could talk about mental health for a long time because it’s so important. But I want to cover one other area: vaccinations. Where are we right now with vaccinations? What is new on the horizon when it comes to vaccines? Dr. Stinson, what are the things you’re recommending to your patients or to families that are new and different?

Stinson: We always assess patients’ vaccination history when they come in for their well visits.

We follow the CDC guidelines for the immunization schedule of recommended vaccines. There are some new vaccines that have been developed since most of us parents were children, and the vaccine recommendations are updated regularly. As new vaccines are tested for safety and efficacy, they’re added to the schedule, and we update our practice accordingly.

We now routinely vaccinate for hepatitis A and B viruses that cause liver disease; chicken pox; and rotavirus, which causes severe diarrheal illness. We also have vaccines for pneumococcus, which is a bacterium that can cause severe infections in children, including pneumonia, meningitis and others. Adding the pneumococcus vaccine has prevented severe illness in children. In adolescence, there are a lot of vaccines that we did not get as children. There are vaccines for meningitis that are extremely important, especially as teenagers go off to college and are living in dormitories and in close proximity to lots of other people, which is how meningitis spreads. We also have the HPV vaccine that we recommend for all children – both boys and girls. It prevents cervical cancer in girls and can prevent other types of genital cancers in boys. It’s recommended as part of the routine vaccine series for pre-adolescent age children.

Rubinger: Dr. Memark, from your perspective, how are Cobb and Douglas doing with their vaccination rates? Talk to me about what the county health agency does in terms of vaccine outreach. And how are you all doing?

Memark: We’re very, very lucky in Cobb and Douglas counties that we have very high vaccine rates.

You remember when Covid started we were talking about “herd immunity?” That’s what’s so important about vaccinations is that when we get a very high uptake rate — in the mid-nineties, 95% and over — then you’re talking about having some good herd immunity that can help protect the most vulnerable in our community – those too young to get vaccinated and those unable to get vaccinated for a variety of reasons.

We have had multiple outbreaks already, at least two good-sized ones, of measles. When that happens, it’s a nightmare. With a recent measles outbreak, we had to reach out to over 3,000 people that were potentially exposed to measles and try to get them prophylaxis.

Usually, we can trace outbreaks back to someone who traveled internationally to a country where vaccination rates aren’t very good. But we do have some outbreaks in the United States where the source never left the country. There are folks that do not believe in vaccinations and that’s how these outbreaks are able to spread.

It’s concerning to see some so-called “dead diseases” make a resurgence. Take polio for example. They are seeing polio in New York. Paralysis caused by polio is something that we didn’t even have to think about anymore. But because some people are choosing not to vaccinate their kids, that could be a real thing all over again. There’s a lot of misinformation on vaccines. I am quite concerned that we are going to see a resurgence of diseases that have been long gone.

For us, it’s very important to be able to do a lot of education and outreach in the community. We are more of a safety net organization. A lot of folks who maybe don’t have insurance or don’t have access can come to us. And even if you do have insurance, you can still come to us.

We offer HPV and shingles vaccines. The HPV one is even available for adults now. We also offer recommended vaccines if you’re planning international travel to specific countries.

What business leaders can do for families and women

Rubinger: Dr. Greaves, I’d like to focus on looking at your community in terms of the fact that they’re also employees of businesses. What are the things employers can do to help keep their female employees healthy so they can be productive parts of their organizations?

Greaves: I think that everyone needs to be aware that there is such a thing as period poverty. For some menstruating women, there is a lack of feminine hygiene products affordable to them, and this is an important socio-economic issue that people often don’t talk about. It affects young girls, but it also affects many adult women. I think establishments should be aware of this issue and consider providing, at no cost, feminine hygiene products. This would help both those that are unable to afford the products, and those that have an unexpected cycle and may not have the products with them that day.

Additionally, we do not provide adequate guaranteed paid maternity and paternity leave for women and partners to adequately recover during the post-partum period. The highest risk of mortality due to cardiovascular disease of pregnancy occurs during the post-partum period, and the risk extends up to one-year post-partum. Imagine a woman not having time to go to the doctor because she’s concerned about missing work and losing income for herself and her family and having to return to work after only six weeks post-delivery. We must ensure that women are able to identify and treat post-partum depression or cardiovascular diseases promptly.

As a society, we need to improve access to healthcare to all women, with reassurance of preservation of livelihood. No one should have to choose between income and health.

Memark: The availability of feminine hygiene products is definitely an issue, but I want to let everyone know that we do have them available at health departments for women and girls who need them, free of charge. We also have great OB/GYN services. There are some people in our community that need that kind of access, and some of those people may be employed by your readers. They may not have health insurance, or they may not necessarily be documented. Those are some of the things that we see, and we can actually help a lot of those women find the resources they may need.

We work a lot on health disparities and also on maternal and infant mortality. We have a grant that can help provide Black women in South Cobb and Douglasville with prenatal care. We also have multiple services that can help families get connected with resources to help them. If a woman is having trouble feeding her baby, or doesn’t know how to find help, we have WIC (Women, Infants and Children) services that can assist her.

Another important issue is contraception. Say you have a baby, and you’re not ready to have another baby. How often does it happen that you end up pregnant again before you were ready and you’re already having a hard time taking care of your first child? We have long-term contraceptives here as well that can help women with family planning.

Rubinger: Dr. Memark, can employers come to the county, to the public system, for this type of assistance as opposed to individuals? If you were talking to a reader of mine who might run a company, how would they interact with you for their employees?

Memark: There are certain things we can help with, depending on your employees. Based on the size of your company and your industry, you may have a lot of part-time employees, and they may not all have health insurance. You may be able to get low-cost or free vaccines for your employees. If your female employees need women’s care, we provide cervical cancer screenings and breast cancer screenings. We also offer family planning services. If an employee does become pregnant and is in need, we can help her. I think that’s huge for a woman in your organization to have that support when she may not otherwise have it. And if you can let her know about our services available, it shows her that you care.

Greaves: Additionally, for employees that are still nursing, it is so important to make sure moms have a safe, clean, private place where they can go to breast pump. This may ease the burden for new moms who need to continue lactation after they return to work.

Rubinger: I think that’s a pretty good way to sort of wrap things up unless there’s anything you all wanted to share. My wife is in the healthcare community herself. She was one of the founding board members of the Health Law Partnership, where she dealt a lot with when a child would come into a hospital and was showing strain, and we found out there was an immigration issue. So, I’ve sort of lived this thing that you’re talking about.

Stinson: I think every family has a story and I think it’s always a good reminder for us, when we’re seeing patients, to remember the humanity behind it.


Dr. Paula Greaves, chief, Women’s Health Service Line, Wellstar.

Dr. Janet Memark, district health director, Cobb & Douglas Health District.

Dr. Carrie Stinson, chief, Pediatric Service Line, Wellstar.


David Rubinger, Atlanta Business Chronicle market president and publisher.


Original Story Published in Atlanta Business Chronicle
Published: July 14, 2023