The Road to Wellville

Physical examinations should be like fingerprints: no two alike.

While we all come with the same basic equipment, individually we have specific needs. Yet, most of us have been indoctrinated to the assembly-line approach to the annual physical.

“The idea of a complete annual physical exam is a 20th century U.S. phenomenon that no other country does,” says Dr. Al Berg, a member of the U.S. Preventive Services Task Force and professor at the University of Washington in Seattle. “There is no scientific backing for it,” says Berg, a family physician. “Having an exam doesn’t ensure good health.”

The idea that a doctor says you’re in reasonably good health for one more year, despite the fact you’re overweight, smoking or otherwise unhealthy, shouldn’t give patients license to continue that behavior, Berg says. The idea of a physical exam should be for the doctor and patient to come up with a strategy for individual good health.

The frequency and content of a physical exam should depend on your vital statistics, your lifestyle, family and social history, and other factors that weigh your risk.

Doctors follow guidelines that are age-, gender- and risk-factor specific to tell them what their priorities with a patient should be. Regular doctor visits for consultations, screenings, immunizations and preventive prescribed care, such as vitamins, are based on these guidelines.

So how can you make the most of your physical exam? Come prepared and know your family history.

“Heredity plays a role that cannot be ignored,” says Dr. Pamela Kushner, a Long Beach family physician. Having immediate relatives with certain medical problems changes how a doctor will treat you.

You should also bring information on all your medications, even nonprescription ones.

“Medications are really important because it helps me to know what I’m dealing with,” Kushner says. “When people are on medications, I usually monitor blood every six months.”

Knowing what medications a patient takes is especially important in treating the elderly, says Dr. Loren Lipson, chief of geriatric medicine at the University of Southern California Medical School.

“Twenty percent of seniors are hospitalized due to medication problems,” he says. “Many seniors have multiple specialists but not a primary care doctor.”

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A physical exam usually begins with the doctor asking general questions regarding personal health habits and vital signs, and a checklist called the “review of systems.” This sets the stage for the actual examination of your body and helps your doctor decide what additional tests or screenings are necessary.

Personal health habits include diet; exercise; sexuality; and caffeine, nicotine, drug and alcohol intake. A doctor should ask about your dental and visual health as well. Honest answers to these and all questions are crucial and lay the groundwork for your physician.

The review of systems helps the doctor assess your physical well-being from head to toe and contains 100 or more questions. Your doctor wants input regarding physical changes in your body. Do you have:

* Chronic sore throats?

* Trouble with hearing?

* Dizziness?

* Tightness in your chest?

* Swelling of feet or ankles?

* Chronic back pain?

* Trouble urinating?

* Trouble sleeping?

“A doctor should be like a data bank,” Kushner says. “The more information you put in, the more I can help you.”

While studies have shown that most people are honest with their physicians, patients need to remember that a doctor’s job is not to judge but to advise.

“You must be your own advocate,” Lipson says. “Don’t be uncomfortable. Physicians cannot be mind readers.”

He suggests that patients start a running list of complaints they wish to discuss a week before their visit.

“Women should come knowing their menstrual history and ready to talk about contraception,” says Dr. Susan Sklar, a Los Alamitos gynecologist on staff at Women’s Hospital in Long Beach. Both women and men should be ready to discuss safe sexual practices.

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So once the actual physical exam begins, what are doctors looking for? Here are some typical areas of inspection and why:

* Eyes: looking at the blood vessels (the eyes are one of the few places where blood vessels can be observed), which are indicators of coronary arterial disease and possible brain tumors; pupils can show neurological problems.

* Ears: looking for blockages, wax buildup and growths.

* Neck and throat: feeling the neck and checking the mouth for masses, growths and hygiene; listening for hardening of the arteries with a stethoscope; checking lymph nodes for irregularities.

* Lungs: listening for respiratory changes, front and back.

* Heart: listening for irregular heartbeats, heart murmurs or signs of heart failure.

* Breasts: examining for texture, growths and tenderness, especially in women and men with family history of cancer.

* Abdomen: checking for liver and spleen size, abdominal growths or masses.

* Groin and genitalia: checking lymph nodes and pelvis.

Men: checking testicles for size, growths and hernia; penis and urethra, for growths.

Women: Checking ovaries and uterus for size, growths and tenderness; Pap smear for cancer.

* Rectal: checking for blood in the stool.

Men: feeling the prostate; checking for size, texture and growths.

Women: checking for growths or tumors.

* Neurological exam: looking for strength and tone in extremities and that reflexes are equal.

* Extremities: looking for swelling and signs of circulatory changes; checking fingernails and toenails for fungus and shape changes; checking for foot abnormalities.

* Skin: looking at texture, moles and unusual growths; checking for enlarged or dilated veins.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Guidelines to Periodic Screenings and Laboratory Testing for men and women

Physical Screenings

Age: 19-39 Frequency: every 1-3 years

Height and weight: yes

Blood pressure: yes

Breast exam (women): yes (starting age 30)

Pelvic exam (women): yes

Testicular exam (men): HR (high risk)

Digital rectal (recommended but scientifically inconclusive): no

Oral cavity exam**: HR

Skin exam: HR / yes

Thyroid palpation**: HR / yes

Cardiac auscultation**: no

Auscultation for carotid bruits**: no

LABORATORY TESTS

Cholesterol check: yes (once every 5 years)

Lipid profile: HR

Pap smear (physician discretion after 3 consecutive normal tests): yes

Hemoglobin: HR

Fasting glucose: HR

Urinalysis: HR

Sexually transmitted diseases: HR

HIV: HR

Tuberculosis: HR

Rubella antibodies (women): HR

Electrocardiogram: HR

Mammogram: HR

Fecal occult blood: no

Colonoscopy: HR

Sigmoidoscopy: no

Bone mineral content**: no

Thyroid function test: HR

*

Age: 40-64

Frequency: every 1-3 years

Height and weight: yes

Blood pressure: yes

Breast exam (women): yes (annually)

Pelvic exam (women): yes

Testicular exam (men): HR

Digital rectal (recommended but scientifically inconclusive): yes

Oral cavity exam**: HR / yes

Skin exam: HR / yes

Thyroid palpation**: HR / yes

Cardiac auscultation**: HR / no

Auscultation for carotid bruits**: HR / no

LABORATORY TESTS

Cholesterol check: yes

Lipid profile: HR

Pap smear (physician discretion after 3 consecutive normal tests): yes

Hemoglobin: HR

Fasting glucose: HR

Urinalysis: HR

Sexually transmitted diseases: HR

HIV: HR

Tuberculosis: HR

Rubella antibodies (women): no

Electrocardiogram: HR

Mammogram: yes (annually at age 50

Fecal occult blood: HR / yes

Colonoscopy: HR

Sigmoidoscopy: yes (every 3- 5 years starting at age 50); HR (frequency individually determined)

Bone mineral content**: HR / no

Thyroid function test: HR

*

Age: 65 and older

Frequency: every year

Height and weight: yes

Blood pressure: yes

Breast exam (women): yes

Pelvic exam (women): yes

Testicular exam (men): HR

Digital rectal (recommended but scientifically inconclusive): yes

Oral cavity exam**: yes

Skin exam: yes

Thyroid palpation**: yes

Cardiac auscultation**: yes

Auscultation for carotid bruits**: HR / no

LABORATORY TESTS

Cholesterol check: yes

Lipid profile: HR

Pap smear (physician discretion after 3 consecutive normal tests): yes

Hemoglobin: HR

Fasting glucose: HR

Urinalysis: yes

Sexually transmitted diseases: HR

HIV: HR

Tuberculosis: HR

Rubella antibodies (women): no

Electrocardiogram: HR

Mammogram: yes

Fecal occult blood: HR

Colonoscopy: yes (every 3-5 years); HR (frequency individually determined)

Sigmoidoscopy: yes (every 3-5 years); HR (frequency individually determined)

Bone mineral content**: no

Thyroid function test: yes

* This chart is strictly a guideline. Content and frequency of any physical exam should be individually tailored. Consult your physician.

* High risk (HR) is determined by you and your physician based on information about your history, lifestyle, physical health and other risks.

** Means there is disagreement in the medical community. Some professional medical associations say the procedure is necessary; some say it’s not; others say only if you are in a high risk category.

Sources: American Academy of Family Physicians, American Medical Assn., U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists.