Dear Doctor: When I was growing up, I saw my doctor annually for a physical exam. So I was surprised when my daughter told me that her physician doesn't believe in them. Do you agree? If not, what should a physical exam include?
Dear Reader: Although there's a trend toward doing away with an annual checkup for healthy adults, both of us believe in and support the practice of a yearly physical exam. It's covered by most insurance policies and, at the very least, is an opportunity to reconnect with your primary care physician. When the annual exam becomes more than just an exercise in gathering data, it's an extremely useful tool for both the physician and the patient.
What exactly does a yearly exam consist of? That depends on each physician. Considering that the annual checkup has been one of the cornerstones of primary care, it's a bit of a surprise to note that there are no guidelines or consensus statements regarding what the visit should entail. We can't speak for other physicians here, but can instead explain what we do in our practices, and why.
In addition to performing a head-to-toe exam, we approach the annual exam as a chance to help our patients take stock. We review the previous year and plan for the future. We go over any active problems the patient may have, and evaluate how a treatment plan is (or isn't) working. We review any medications the patient is taking, with an eye to either renewing, changing or eliminating them. We update family medical histories to pinpoint any potential hereditary risk factors, such as certain cancers, coronary artery disease or Alzheimer's disease.
We believe that the results of these discussions, as well as the information gleaned from the screening and diagnostic tests, help patients obtain a clear picture of their physical health. They also offer patients an opportunity to set goals and play an active role in their health care. The lab tests and screenings that we recommend can not only reveal potential problems, but also provide an important baseline against which any future changes or anomalies can be evaluated.
Specifically, we review blood pressure, heart rate, weight and body mass index. For labs, we order a complete blood count, kidney, liver and thyroid function tests, diabetes and cholesterol screenings, and a check of vitamin D levels. For women, we recommend age-appropriate screening with mammogram, Pap smear and bone density test. With men, we discuss the risks and benefits of the PSA test, which screens for prostate cancer. For patients over 50, we recommend colon cancer screening with a colonoscopy. We review and advise vaccines.
The argument against an annual physical is that, for healthy adults, the tests are unnecessary. However, we believe that our approach yields a multidimensional picture of a person's health journey. It makes it more likely we will catch certain conditions early, when they are easier and less costly to cure. In our opinion, the annual physical exam empowers our patients and paves the way to better health.
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