Today I am going to talk about getting a routine physical; but first, I need to take care of some business.
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I have to tell you, I am really thrilled with the reception this podcast has gotten. Thanks for listening and keep spreading the word. For you doctors out there, feel free to tell your patients about it. I write it with the intent of answering questions my own patients frequently ask me.
It’s disclaimer time! I do this every podcast, so regular listeners can join in: this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Very good! Maybe I’ll put it to music in the future.
Your Annual Physical
Today’s question comes from Rich, who seems a little nervous. He has turned 40, and wants to know about getting a physical. Men who turn 40 get nervous when thinking about physicals. Rich wonders what questions he should ask when he has the physical and what information he should walk away with? How can he make sure he gets his money’s worth out of his doctor’s visit?
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The Routine Physical Myth
Let me dispel a myth about routine physicals. They are not magical. Having a yearly physical is not the most important thing you can do for your health. I am not angry with my healthy patients who don’t come in every year so I can embarrass them. People don’t need to have a gazillion lab tests drawn every year to prove that they are healthy.
Sound radical? Let me explain.
On the cholesterol podcast I explained that, as a patient, it is very important to know your risk. I used the analogy of people living in Florida needing to watch out for hurricanes and prepare for them in case they come. But folks in Idaho don’t need to stay glued to the Weather Channel’s hurricane watches (unless they like the snazzy music during the local weather thing).
The same is true for your health. The main benefit from getting a “routine physical” is not that your doctor pushes on your spleen or orders a bunch of tests; it is that you sit down with your doctor and review your risk factors, figuring out the big picture of your health.
How to Determine Your Medical Risks
So when you sit down with your doctor, what things should you be discussing? What things determine your risk?
- Heredity – If everyone in your family has a heart attack when they are young, it is smart to worry about heart disease early. If they all lived to be 100, then not so much. Discuss the significance of these facts. Some diseases are more significant to have in your family tree than others. Colon cancer, for example, has a strong genetic link, whereas leukemia is not as clearly genetic.
- Lifestyle – Do you smoke? Do you drink? Do you spend your time in front of the TV eating cookie dough ice cream? Do you work around asbestos or lead? All of these facts need to be discussed because they can affect your health.
- Your Medical History – Diabetes, high blood pressure, past history of cancer, or prolonged use of certain medications will play a big part in determining what has to be monitored or watched out for.
- Age and sex – people who are in their 20’s are more likely to die from accidents than they are of cancer. Men have heart disease earlier than women, but women are much more at risk for breast cancer.
You can make your visit fruitful by doing your homework beforehand. Be ready to share any changes in your family history, any new allergies or medications (including over-the-counter), and any changes to your lifestyle. Also look at the latest preventive medicine guidelines so you’ll know what to expect and what questions to ask. I’ll put some links to these guidelines end of the show notes.
What Happens During the Physical Exam?
So what’s the next step? Usually the doctor makes you get naked and put on a paper gown, and then leaves you to shiver on the exam room table for 10-20 minutes while he gets the stethoscope out of the freezer.
Seriously, the next step is the physical exam. To be honest, the physical exam is probably the least important part of this entire process. I am not saying it shouldn’t be done, but a good history and discussion of risk factors is far more important than a thorough examination. The most important parts of the exam are the blood pressure, weight, breath sounds, and heart exam. Women, of course, get their own special exam.
Which Medical Tests Do You Need?
Finally, the preventive medicine is done. That is where you get stabbed, poked, and sent off to get embarrassing tests. Some people only feel like they’ve gotten a good exam if they have a lot of blood tests drawn and procedures run. Money’s the only thing in the way, right? Wrong.
If I did a routine electrocardiogram (or EKG) on low-risk patients, I would cause lots of trouble and probably not help prevent serious problems. An abnormal EKG on a healthy 20 year-old is unlikely to represent anything significant. It is more likely to be an error in testing or a peculiarity of that person. Beyond the worry I cause them is the further testing they must go through to show that they are just fine – which is what I basically knew before I did the EKG. It’s not just a waste of time and money; it could eventually lead to risky tests.
So a test should only be done to someone when the benefit outweighs the risk. An EKG every few years on a person with high blood pressure or diabetes is much more likely to identify hidden problems than doing them on low-risk people. The same is true for running routine blood panels and even parts of the physical exam. Everything should be done with a purpose. It’s much better to know where your target is— what problems you are trying to diagnose-- than to shoot blindly and hope you hit it by chance.
These are the preventive medicine procedures that I think are most important:
- Cholesterol. I explain this in detail in my cholesterol podcast. This should be checked every 3-5 years unless you are at high risk for heart disease.
- Blood Pressure. It’s probably good to have this checked every 1-2 years.
- Cancer screening tests, including pap smears and mammograms for women, and prostate cancer screening for men. Colon cancer screening tests should be done for those people at risk (which includes everyone over age 50).
- Immunizations against tetanus, shingles, pneumonia, and other diseases should be done according to recommended guidelines.
- You should discuss ways to change your lifestyle to reduce your future risk of disease. The earlier you make changes like quitting smoking, the bigger the benefit.
One additional thing: If you have tests run by your doctor and don’t hear about the results, don’t assume “no news is good news.” You should always find out the results of any test you have done, and what those results mean.
Be Prepared for your Doctor’s Visit
The good news is that people like Rich who are pretty healthy are going to have less frequent and more boring visits to their doctor. Believe me, boring visits are OK; you don’t want to be an interesting patient for your doctor.
So here is my answer to Rich’s question in a nutshell:
- You should walk into the exam with accurate personal information.
- Then discuss the significance of this with your doctor and learn your risk.
- Your doctor should examine you and order tests to address your risk factors.
- You should always walk out with a plan to prevent disease or detect it early.
Maybe someday we will get those full body scanners they have on Star Trek that can prove that we are healthy. But as of now, we need to use that boring thing called common sense.
I hope that answers your question.
Don’t forget to get your free trial of GoToMyPC by visiting GoToMyPC.com/podcast.
If you have questions you want answered, send them to housecalldoctor@quickanddirtytips.com or call 206-337-5895. If you Twitter, my username is “@housecalldoc”, and I also have a Facebook page under “House Call Doctor.”
And you can always find me at my blog, Musings of a Distractible Mind, at distractible.org.
Catch you next time! Stay Healthy!
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Preventive health Guidelines:
