DEAR DOCTORS: I am baffled that what used to be a thorough and comprehensive physical exam is now just a few questions, taking some vital signs and a few blood tests. No checking your eyes, throat, glands or reflexes. No breast exam. Why has this changed? What constitutes a complete physical these days?
DEAR READER: The annual physical exam has long been considered a cornerstone of preventive healthcare. But as surprising as it may seem, there are no official guidelines as to what it should entail. At the same time, some doctors and medical practices have recently begun to move away from offering their patients a yearly checkup. This change has been prompted by several studies that, in parsing large troves of healthcare data, have questioned the efficacy of this yearly ritual. However, for both of us, the annual physical exam continues to be an important part of our practices.
Absent the existence of official guidelines for the annual physical, we can only discuss the specifics of our own approaches. We see it as an overall assessment of someone's general health and as a chance to reconnect with the patient. It's an opportunity for both the patient and doctor to take stock of the previous year and to assess any changes. It's also an opportunity to set new goals and plan for the future.
In our practices, the annual exam begins with a review of the person's medical history, along with any updates that are needed. This includes illnesses or injuries, vaccinations, medications prescribed by other doctors and mental health updates. Family medical history, including new instances of diseases such as certain cancers, coronary artery disease or Alzheimer's disease get updated as well. Patients often deal with smaller, less pressing medical issues on their own. Adding information about these to their medical history can prove to be important for future visits.
When we conduct a physical exam, we review each patient's blood pressure, heart rate, weight and body mass index. If there have been significant changes, we address them. We explore possible causes and discuss changes to diet, medication or behaviour that may be needed. When it comes to diagnostic tests, we order a complete blood count; tests that analyse liver, kidney and thyroid function; as well as diabetes and cholesterol screenings. We also check vitamin D levels. We review those results, discuss them with the patient and offer mitigations if needed.
When screening tests such as mammograms, Pap smears and bone density tests are called for, we recommend them to our patients. We also discuss the risks and benefits of the PSA test, which screens for prostate cancer. In keeping with newly updated guidelines, we recommend colon cancer screening with a colonoscopy for patients 45 and older.
The information collected in an annual physical exam can help patients get a better understanding of their physical well-being. It also provides a useful baseline against which future changes or anomalies can be evaluated. In our view, this yearly screening empowers patients, strengthens their relationship with their healthcare providers and paves the way to better health. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
