Health care experts are saying the annual physical is dead. To take its place comes the “periodic health examination.” This version of the traditional checkup abandons the cookie-cutter mold for a more customized exam based on the individual’s health risks. That means you have to become more involved in order to get the most out of your physical.
You feel fine: no aches or pains, no shortness of breath, nothing out of the ordinary. So why should you see your doctor? Well, there are several reasons. A regular checkup, now being referred to as a “periodic health examination” (PHE), can help prevent diseases before they get a foothold or catch health problems at early stages when they’re easier to control or cure. Another great benefit of such visits is that over time you and your doctor develop a rapport and mutual trust.
The type of doctor you should go to for PHEs is a primary care physician. These experts not only keep close tabs on their patients’ health but on their use of specialty care as well. Another important part of their job is to educate you about measures that will keep serious medical problems from occurring in the first place. The following doctors qualify as primary care: family practitioners (general practitioners) can treat everyone in your family because they’re trained in several basic medical disciplines, including internal medicine, pediatrics, obstetrics, gynecology, general surgery and psychiatry. Internists diagnose and “medically” (without surgery) treat disease in adults. And pediatricians care for and treat children from birth through the teen years. Everyone agrees that regular checkups are a valuable tool in maintaining good health, but experts disagree about how often people should have them and which tests they should include. Discuss what frequency is best for you with your doctor and check to see what your insurance will cover.
What Happens During a Physical?
The following are the four basic components of a routine physical:
1) Your Medical History. Prior to your physical examination, you should tell your doctor about your diet, exercise, alcohol and tobacco use, sexual behavior, family history of diseases, such as cancer, diabetes or heart attack, and any symptoms you may be feeling. This information is vital because it affects your risk factors for various illnesses and, consequently, the tests your doctor may decide to give you. So don’t wait for the doctor to ask you about everything-volunteer as many details as you think are relevant. And if your doctor doesn’t seem to have enough time for you, speak up. If he or she is still not receptive to your concerns, you may want to find another physician.
2) Physical Exam. The doctor will check your height, weight and blood pressure, and listen to your heart, lungs and carotid artery for abnormalities such as a heart murmur or lung obstruction. A doctor who is very thorough may also check your mouth, ears, lymph nodes, thyroid and rectum and feel your abdomen for abnormalities, and scan your skin for signs of melanoma (skin cancer).
3) Counseling. After the medical history and physical exam, your doctor should talk to you about any risk factors you may have and discuss what habits you should change to maintain good health. The physician will also tell you what lab tests you need and how often you should have them. This is also a good time to decide with your doctor how often you should have PHEs.
4) Lab Tests. Some tests, such as mammographies and pap smears, are usually based on guidelines set by organizations like the American College of Obstetricians and Gynecologists and the National Cancer Institute. In addition, your doctor may want to run tests for diabetes, sexually transmitted diseases, tuberculosis or prostate cancer, and to screen your heart, liver, kidney, blood and urine. The extent of other tests your doctor recommends will be determined by any risk factors you may have based on your medical or family history.
Staying on Top of Your Health: How Often Should You Be Tested?
| Routine tests recommended by the AMA* | Frequency For People Not At High Risk | Frequency For People At High Risk |
| Eye Examination To detect visual defects or eye muscle disorders and to look for signs of disease, such as glaucoma. | Teens to Age 30: Every 2 years if you have problems with your vision Adults 30 to 50: Every 2 years (if you have good vision start exams at 40) Adults Over 50: Every 2 years | Having diabetes or high blood pressure or a family history of glaucoma Teens to Age 30: At least once a year Adults 30 to 50: About once a year Adults Over 50: At least once a year |
| Dental Checkup To check on the health of the teeth, gums, tongue and mouth, and to look for oral cancer. | Teens to Age 30: Every six months until age 21, then at least once a year Adults 30 to 50: At least once a year Adults Over 50: Every 1-2 years | Chewing or smoking tobacco Teens to Age 30: As dentist recommends Adults 30 to 50: As dentist recommends Adults Over 50: As dentist recommends |
| Cervical (PAP) Smear Women should have a Cervical (PAP) Smear to detect abnormal cells in the cervical lining that could develop into cancer. | Teens to Age 30: Annually for women over 18 and all sexually active women Adults 30 to 50: Every 1-3 years Adults Over 50: Every 3-5 years | Having been diagnosed and treated for pre-cancerous changes or for herpes or genital warts Teens to Age 30: Annually Adults 30 to 50: Annually Adults Over 50: Annually |
| Blood Pressure Blood Pressure measurement to detect hypertension at an early stage, before complications develop. | Teens to Age 30: Begin at age 20; then every 3-5 years Adults 30 to 50: Every 1-3 years Adults Over 50: Annually | Having a family history of it, heart or kidney disease, stroke, diabetes, or being overweight or taking oral contraceptives Teens to Age 30: Annually Adults 30 to 50: Annually Adults Over 50: Annually |
| Blood Cholesterol Test Detects people at high risk of coronary heart disease. | Teens to Age 30: During first physical Adults 30 to 50: Depends on results of last test, if normal, repeat in 3-5 years Adults Over 50: Same as for ages 30-50 | Having a family history of early-onset coronary heart disease Teens to Age 30: If abnormal, follow your doctor’s advice Adults 30 to 50: If abnormal, follow your doctor’s advice Adults Over 50: If abnormal, follow your doctor’s advice |
| Mammography (1) Detects breast cancer early, before it can be felt during a physical examination. | Teens to Age 30: None Adults 30 to 50: Once between 35 and 40; every 1-2 years between 40 and 50 Adults Over 50: Annually | Having a close relative with breast or colon cancer Teens to Age 30: None Adults 30 to 50: Every 1-2 years, beginning at age 35 Adults Over 50: Annually |
| Rectum and Colon Exam There are three separate tests to detect colorectal cancer: a) Digital rectal exam; b) Blood in the stool; c).Sygmoidoscopy. | Teens to Age 30: Usually not necessary Adults 30 to 50: a) Annually after 40 Adults Over 50: a) Annually; b) Annually; c) Every 3-5 years | Having a close family member with cancer of the colon or rectum, polyps of the rectum, or long-standing ulcerative colitis Teens to Age 30: a) Annually after age 20 Adults 30 to 50: a) Annually; b) Annually ; c) Every 3-5 years Adults Over 50: Same as for ages 30 to 50 |
| Complete Physical Exam Determines your health status and develops your relationship with your doctor. | Teens to Age 30: Twice in your 20’s Adults 30 to 65: Every 1-2 years or as your doctor recommends Adults Over 65: Every year | Teens to Age 30: Twice in your 20’s Adults 30 to 65: Every 1-2 years or as your doctor recommends Adults Over 65: Every year |
*Source: American Medical Association (AMA) Encyclopedia of Medicine, 1994.
(1) The National Cancer Institute recently said there is no evidence that regular mammograms reduce the death rate from breast cancer of women under 50.
