I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn’t matter. It is an essential part of the development and continuation of the doctor patient relationship.
The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history and physical exam and use the data to coordinate a care plan for you which is personalized.
The history of present illness illustrates any immediate and current concerns. The past history reviews previous illness and how those problems may affect your current and future health. A family history presents genetic data which may affect you and your loved ones in the future. It updates your physician on what changes have occurred in your family’s’ health that may affect you. The social history looks at your school and employment history as well as lifestyle choices. Are you working with industrial toxins or in a field prone to certain predictable and preventable disease? Are you smoking? How much alcohol is in your diet? Are you partaking in physical exercise? Are you in a stable relationship? All these factors influence your health and choices. Do you have a living will? Who is your health care surrogate and who are your emergency contacts? It is a great time to review your allergies and medications both prescription and over the counter vitamins, minerals, herbs and supplements. Last but not least we look at checkups, vaccinations and immunizations. Are you current on tetanus shots? Do you know about pneumonia vaccine and zostavax for shingles? Have you had your eyes checked for glaucoma? When did you last see a dentist? What about skin checks, colonoscopies, mammograms, pap smears and bone densitometry? The history session ends with a complete review of all your body systems. By asking a laundry list of questions we hope to jog your memory to discuss all those little items you meant to ask about but may have forgotten to bring up.
The physical exam is used to support the hypothesis and answer the questions raised during the history taking session. It should be thorough looking at you from the top of your head to the bottom of your feet without skipping any orifices in between. The findings of the exam, coupled with the history session, will determine which laboratory tests, if any, your doctor will choose to order. In thirty years of practice, I am rarely surprised by the results of a blood test if I have done a thorough and complete history and exam. Patients seem to feel something magical about lab tests but the truth is that a thorough and experienced clinician usually knows what the findings will be before he orders the test.
The complete exam should be followed by a consultative review session during which the doctor explains the findings of the history, exam and lab and makes suggestions. A care plan should be established at that session and a defined follow-up plan suggested and scheduled.
During your physical exam the doctor is learning a great deal about you. From the way you dress, to the way you carry yourself to your speech pattern; the physician is seeing you while you are healthy. It is much easier to diagnose a problem if you have had the opportunity to see the patient when everything is normal. This knowledge of your normal appearance is what allows your doctor to find a problem in its initial stages rather than a crisis requiring a visit to a hospital emergency department. It is all part of the concept of longitudinal long term care and relationship.
Find a doctor. Schedule your yearly checkups. If you find a physician you trust and respect stick with them. It may save your life.
Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.
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