Doctor In Your House: Make your yearly physical exam worthwhile
BY EVAN L. LIPKIS, MD Special Columnist
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The utility of the general physical examination has recently come under fire.
In the U.S. and the U.K., primary care physicians commonly take a history, perform an examination and do simple lab tests to screen for disease.
However, whether general health checks provide any tangible benefits remains uncertain. In a meta-analysis, Cochrane investigators determined the effects of general health checks on diseases in unselected adults recruited from the general population, primary care practices, and health plans. Fourteen randomized trials that involved 183,000 adults were thoroughly analyzed.
Overall, general health checks had no effect on overall death rates. Likewise, general health checks had no effect on the incidence of diseases (e.g., heart attacks), hospitalizations, work absences, disability, patient worry, or physician visits.
However, many trials showed that general health checks resulted in more diagnoses (e.g., high blood pressure, elevated cholesterol, obesity), more use of antihypertensive drugs, and better self-reported health.
Should you still get a general checkup?
Frankly, I was disturbed to see such results but even though the quantity of life was not changed, the actual quality of life was not evaluated in detail.
Patients reported better-perceived health, which implies improved quality of life.
I believe that a properly done history and physical exam can indeed save lives and improve the quality of life. After the exam is completed, the physician should utilize the history, physical and labs to help solve the patient's medical complaints. Additionally, a list of reminders should be given to the patient regarding prevention and treatment of diseases.
Dr Roizen, author of The Real Age points out what activities make you younger: take the right vitamins (6 years younger), keep your blood pressure at 115/75 as opposed to 160/90 (25 years younger), reduce stress (30 years younger), floss and brush your teeth (6.5 years younger), walking 40 minutes daily (5 years younger), wearing seat belts in the front and the back (3.5 years younger), maintain a healthy monogamous sex life (1.5 to 8 years younger), take your medicines regularly and follow your doctor's advice (12 years younger). Screening colonoscopy, mammography, vaccinations, dietary adherence and bone density screening can also be quite useful.
All of the above factors as well as current medical problems can be reviewed during the screening physical exam.
The doctor's job is to be your coach and help you to achieve both the preventative and treatment goals.
What health provider might provide me with a useful physical?
1) The doctor should be board certified. Certification is required every 10 years.
2) Your health professional should be a good listener and take the time to review your medical problems. Interestingly, the history is the most important part of the exam.
Are you waiting 3 months or more to schedule a physical exam? Do you sit in the waiting room for more than 30 minutes? Does the doc take more than a day to answer your phone calls? If this is the case, consider switching to a physician who is less rushed and not as busy.
3) Is your doctor on staff at multiple hospitals and nursing facilities? Over 95% of your medical care will occur in a physician's office so if your doc is traveling to many health facilities, does he or she have enough time for you?
4) Is your health provider empathetic and friendly? These are important traits in addition to medical knowledge. You are more likely to better explain your medical problems to a caring doctor in a relaxed environment.
5) Respectfully interview the doctor just as if you were hiring a contractor. Observe how the staff treats you. If the physician won't interview, then possibly there is an ego problem or the doc is too busy.
Doctor's Summary: The father of modern medicine, Sir William Osler, MD said, "Listen to thy patient and therein lies your answer." The physical exam done by the RIGHT healthcare provider may very well add years to your life.
Dr. Evan Lipkis, MD, is a physician, author and lecturer based in Glenview, Illinois. The advice contained in this column is for informational purposes only. Readers should consult with their physician to evaluate any illness or medical condition. Contact Dr. Lipkis through his web site at: www.drlipkis.com