Let's Get Physicals

By Dr. David Lipschitz

May 15, 2009 6 min read


Everyone needs a comprehensive exam after 50

Dr. David Lipschitz

Creators News Service

Here's a health tip for 2009: After age 50, you must have a comprehensive physical from a primary care physician whom you like, trust and respect. If you are completely healthy, every two years could be sufficient, but from age 60 onward, it should be at least annually.

The intensity of the annual examinations can vary a great deal. In some circumstances, screenings can involve evaluations by multiple physicians, many blood tests, X-rays, imaging studies (such as CT scans), echocardiograms and treadmill stress tests. At the other extreme, some annual physicals offer perfunctory examinations with very little done at all. So rather than being passive and trusting your physician to do whatever he deems best, you must take steps to be well-prepared before ever putting on the paper gown. Know what the encounter should entail, what tests to expect, what questions should be asked and the cost.

Because of the fast-paced, bottom line-driven business of health care, many patients are shortchanged when they see their doctors for initial visits. Oftentimes, you spend more time with office staff than with your physician and get little opportunity to discuss your health, history and concerns. Demand that your physician give you adequate time. If your first visit does not entail at least 40 minutes of face time with your physician, it is likely not thorough enough, and potential problems could be missed.

Before the examination begins, make sure you tell your physician that you seek to be educated about how to stay healthy and prevent disease. This is important because it will let your doctor know that you are serious about your health and willing to take every possible step to avoid illness.

Most physicians require that you complete a questionnaire prior to the visit, which provides information about your complaints, medications taken, illnesses and surgeries and provides a detailed family history to identify diseases you may be at risk of getting, lifestyle habits (smoking, alcohol, diet, etc.) and social history (marriage, children, hobbies, the importance of religion in your life, and sexual activity). The questionnaire also should involve a "review of systems," in which you are asked whether you have any symptoms that would suggest any underlying disease. For example, if you complain of shortness of breath or chest pain, that could suggest coronary artery disease. Your doctor should spend at least 15 minutes taking this history.

Before coming to any diagnoses or determining whether additional tests are needed, your physician must perform a thorough, head-to-toe examination. If you do not remove your clothes and put on a gown, the examination never will be thorough or accurate enough.

The first examination should be very detailed, including blood pressure and measurements in both arms while sitting and standing. It also should include a rectal examination and, for a woman, a breast and pelvic examination. This sort of compulsory examination could help identify problems such as high blood pressure, the narrowing of the carotid artery and heart murmurs.

The history and the information obtained during the examination should tell your doctor virtually everything about your state of health. Blood tests and other screening tests should verify a doctor's initial impression. Your risk factor for illness will determine how aggressively you will be screened for diseases. Screening tests are an important component of nearly every medical checkup; however, it is imperative that your physician educate you about why each test is done, what you should expect and what evidence exists to support that course of action.

Blood tests generally screen for diseases such as anemia, hypothyroidism and diabetes and for risk factors for heart disease, such as cholesterol. Make sure that your physician only performs tests approved by the U.S. Preventive Services Task Force. For example, an annual stress test that screens for coronary artery disease is deemed unnecessary in most circumstances.

Once all the information is collated, a second visit should include a discussion of the results and, most importantly, counseling to assist you in any health problems that you have. A good primary care physician educates patients about preventive measures to ensure that they stay healthy and happy. This approach should empower you to be more involved in your own health and ensure that you receive the best care available.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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