Hi everyone! I’m feeling a little prickly today because I have been fired. No really, I got fired recently by a husband and wife who were angry I didn’t do certain tests with the husband’s physical.
Turns out their last physician performed certain tests during their physicals that are not recommended, and this particular couple is of the opinion that doing a test is always better than NOT doing them.
So since I declined (with an explanation) to do these tests they felt I was not a good doctor.
It seems to me that these two are not the only patients who don’t know what a “complete physical” entails. Let’s talk about it!
A “complete physical” or “wellness exam” is an opportunity for your doctor to go over your entire medical history, update your chart with things that have happened since the last visit, and make sure your medication and allergy lists are correct.
Your primary care doctor is the one who keeps all these things up to date. This is why it’s important to have your physical every year. If you get sick or need to see a specialist, your primary care doctor is the one folks will ask for records.
Your physical should include an examination and a discussion of your screening needs. Your doctor should make sure your vaccines are up-to-date. And you should go home with guidance on eating healthy, vitamin and supplement use, exercise, and harm reduction measures like using condoms with sexual activity, moderation in alcohol use, wearing your seatbelt and bike helmet, and wearing sunscreen.
For women your visit should review whether your Pap test and mammogram are up to date. Yes, your primary care doctor does Pap tests. You may need a bone density test based on your age and risk factors.
For men, there should be a discussion of prostate cancer risk and current screening recommendations, which are a little controversial. The current recommendation is NOT to screen men unless they are Black or have a father or brother with prostate cancer.
Both men and women should have their colorectal cancer screening recommendations reviewed. There are several options including colonoscopy and Cologuard, depending on age, family history and previous screening results. And both men and women should have labs ordered periodically to check blood sugar and cholesterol.
That’s a lot! So what is NOT included in a complete physical?
Urinalysis – Except in pregnant women, screening urinalysis has little or no value. It is common for a perfectly healthy person to have a small amount of protein or blood in the urine. Screening will turn these findings up and result in anxiety and additional testing. However, if someone has a strong family history of kidney disease, or has high blood pressure or diabetes, testing may be valuable.
EKG – Again, EKGs are an imprecise tool. It is common for patients with perfectly healthy hearts to have minor abnormalities on their EKG. This again leads to anxiety and unnecessary additional testing. If one is concerned about their heart risk, you can ask for a coronary CT (coronary calcium score). This is a much better measure of heart risk as it measures the amount of plaque in the coronary arteries.
These two tests are the most common inappropriately-ordered tests done with a wellness visit. The complete physical is a very valuable tool in keeping you as healthy as possible. You should definitely get one every year. Just be aware of “extras” that may cost more and don’t add to your care.
Want more information about appropriate testing and treatment? Please see the American Board of Internal Medicine’s Choosing Wisely site and app. Yes, there’s an app for that!