KEEP YOUR HEALTH AND WELL-BEING ON TRACK WITH PERIODIC PHYSICALS
By: Ken Cohen, M.D., F.A.C.P., CMO
Evergreen Internal Medicine
Let’s talk about the “Yearly Physical”. Contemporary medical literature has questioned the value of the visit for the periodic health examination based on the low likelihood of discovering a significant medical problem solely during the actual physical examination. While the physical exam will sometimes discover important issues such as an elevated blood pressure, a new heart murmur, or an early skin cancer, there are at least three other important components of this periodic encounter that merit discussion.
The first relates to the routine health screenings that include cancer screenings, bone density monitoring, cholesterol and diabetes lab tests, among others. Some of these are indicated for everyone and others only for people at high risk. Some screenings, such as prostate cancer screening, may be of very limited value altogether. Discussion of these screenings with your physician can optimize those that best suit the individual. In addition, current guidelines are also very complex. For example, finding a colon polyp during a colonoscopy may warrant a repeat colonoscopy in 1,3,5,7, or 10 years, depending on what the polyp looked like under the microscope. Currently, it is estimated that about a third of colonoscopies are done earlier than is necessary. On the other hand, a bone density exam might be due for a repeat in 1, 2, or 5 years, depending on the result. The periodic health examination is the most accurate way to keep up with these multiple screenings, each of which has similar variability with respect to whom and how often it should be done.
The second area of importance is the Immunization schedule. There are currently 8 Adult vaccinations, all of which are given at different times and frequencies. The Pediatric immunization schedule is far more complex, with 15 different vaccinations. The periodic health examination has been shown to be a very effective means of completing vaccinations on schedule without duplication or missed vaccinations.
Lastly, and most importantly, are the interventions around genetic and lifestyle counseling. In all of us, both our longevity and our quality of life are closely linked to these two elements. One of the great values of the periodic health examination is the analysis of one’s individual risk for future health problems, along with the early interventions that can be put in place to help prevent these problems. Take, for example, an individual with a mildly elevated weight and high normal blood pressure and blood sugar, all of which are extremely common. Although any single one of these would not markedly increase risk of future stroke and heart attack, the combination of the three predicts a far higher future risk of early heart disease. While none of these factors alone would meet the threshold for intervention, the combination of the three surely might and would go unnoticed without the periodic health examination.
Interventions could include diet and lifestyle changes to reduce future risk, or medication where indicated. An individual with a family history of early heart disease and a mildly elevated cholesterol level would not need drug treatment, according to current guidelines; however, this is a situation where vascular screening may be valuable. The results could be normal and therefore reassuring, or they could indicate the presence of early plaque buildup. In the latter case, intense diet changes or cholesterol reducing medication could prevent the development of early coronary heart disease. Similar intense screening programs may be indicated in people with strong family histories of certain cancers.
The periodic health examination does not necessarily need to occur yearly. It may be as infrequent as every three years in young healthy people, up to yearly in those over age 50. Your personal physician will help you decide on the frequency based upon your age and health risks. In summary, although there are limits to what can be detected on a yearly physical examination, the combined benefit of appropriately timed health screenings, complete immunizations, and optimal attention to lifestyle, genes, and future health risks contribute significant value to the periodic health examination.