November 17, 2006

‘Doc, I’m feeling fine. Why do I need a check-up?’

By Donna Lee, M.D.
Special to the Times

This article contains general medical information to help you understand the importance of annual physicals; it is not a substitute for personal visits with your own physician. Since every patient’s situation is unique, please contact your personal physician for specific advice regarding your health.

There is no question that both preventive care and early detection save lives. By detecting high blood pressure and then lowering it with exercise or medications, a person can reduce his risk of heart attack or stroke. By finding early colon cancer while it is still in the polyp stage, a patient can be cured without chemotherapy or sometimes even without surgery.

Check-ups are more than the actual undressing and exam portion. They allow me to go through the list of recommended tests to see if a patient is up to date on everything. I can also update his/her chart on any new family history or lifestyle changes. When a patient comes to my office for a sinus infection or acid reflux, I often do not have time to remind a woman that her mammogram is due next month.

In a perfect world, your physician would formulate a plan with you at the first appointment, and you would automatically get reminders from some central computer system linked to your insurance company (to make sure the tests are covered) every time you were due for a test, even if you did not need to see your physician for anything else during the year. But we don’t live in a perfect world, and insurance companies do not want to take this responsibility, so scheduling a physical allows your physician to actually spend time going over what is recommended for your situation or risk factors.

You can make the best use of your physical if you schedule it while you are well. This does not mean you should cancel your physical if you get sick right before. In fact, you should use that appointment to take care of the illness. If you are someone who likes to save up all the minor complaints for one appointment, feel free to write a list to help you remember all your questions. But if you have many issues that require extensive discussion or treatment, the physical may end up being postponed for another day. Please do not wait for a physical to discuss an urgent complaint (like chest pain), make an appointment right away and let the office know over the phone that the appointment is for chest pain.

What are you checking with the blood tests?
Every physician differs slightly on what labs they think are important to do as part of a physical. I usually check for things patients request (cholesterol or HIV test) that are asymptomatic but can lead to significant disease if not caught early (thyroid dysfunction or diabetes), or that are indicated because of an existing illness (urinalysis for patients with high blood pressure). My typical panel for a healthy patient includes a cholesterol panel, a diabetes screen, a liver and kidney panel, an anemia screen, and a thyroid test. After a certain age, tests like a PSA for the prostate or stool tests for blood may become standard.

There are times when a patient requests a specific test that is not useful in a screening environment, and I explain to the patient why that is so. Your physician usually has a good reason for ordering something or not ordering something, so be sure to check with him or her if you do not know the reason.

Why do you ask me so many questions while you are examining me?
Part of a typical exam is a process called “review of systems.” Most physicians use certain parts of the exam as cues to remember to ask the patient about symptoms related to that organ system that the patient may not have thought
to mention.

What are you actually checking with the physical exam itself?
There are some diseases that have absolutely no symptoms, but have signs that are detectable on physical exam. High blood pressure is the most important one of these. People do not feel sick from high blood pressure, but leaving it untreated can increase risk of heart attacks, strokes, and kidney disease. Some other portions of the exam that can greatly impact a patient’s life are listening for signs of arterial narrowing in the neck and abdomen, looking at the skin for early skin cancers, and finding lymph nodes that the patient was not aware of.

What about paps?
I do not usually group paps with annual physicals because I do not want to shortchange my female patients by trying to rush through the physical and review of preventive care in order to make time for the pap at the end. Pap smears are widely accepted as something that should be done every year. I ask my patients to schedule a separate visit for their paps or to have them done by their gynecologist.

So what should I do now?
Be proactive about your health, since you are the one ultimately responsible. If you are healthy and would like to stay that way, call your primary care physician to see if you are due for a physical or other preventive health tests. If you have a chronic illness, make sure you follow up with your doctor at the recommended intervals. But your doctor may be busy focusing on your chronic conditions; if he or she has not mentioned a physical for a while, take the initiative and ask if you should have one!

Dr. Lee is board certified in internal medicine and has recently moved her practice to Evergreen. She is also the medical director of Clarity Medical Spa. She has a special interest in cosmetic dermatology and patient education. Contact her office at (408) 270-3877 or www.claritymedicalspa.com.