Yearly physical?

[lilnoelle]

Can anyone tell me (an MS0) what the normal tests that are done on a yearly physical. I ask because I had one yesterday and felt like it was somewhat worthless and I want to see if I'm being too harsh on the doctor or if the doctor really didn't do what she was supposed to. Basically, the nurse checked my blood pressure, the doctor spent about five minutes with me and during that time she looked into my eyes, ears, palpated my abdomen and listened to my breathing. Oh, and she asked if I had any questions or was concerned about anything. That was it. honestly, its hard for me to understand how she could catch any problems with that physical. Oh, and that was the first physical I'd had at that office.

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[skypilot]

There are separate guidlines for men and women.

http://www.aafp.org/online/en/home/clinical/exam/agecharts.html

 

[deleted87716]

You didn't say how old you are, so it's impossible for me to answer. I'm surprised that you didn't receive a pelvic exam and Pap smear, and at least some basic laboratory work (CBC, lipids, glucose), regardless of your age.

Review the link that Skypilot provided. It will probably answer your questions.

 

[krgrov2]

If your hoping the doc will find a problem you are trying to hide, try not hiding it. It sounds like he/she covered the basics for a presumably healthy young person. CV, Resp, GI, HEENT. It sounds like you missed out on a Neuro exam, but if you are walking and talking and able to focus on another person, its unlikely you'll find evidence of a lurking brain tumor even with a complete neuro exam.

Remember, you can tell alot about a person's health just by the quick observation you have of them doing normal stuff.

Your chief complaint should direct the exam as well.

The more experience you get, the faster it will be, too.

Most of us do not routinely percuss the lungs, listen for murmurs in all positions or look at your toenails, unless you direct us there. For example, if I hear a faint murmur or you complain of palpitations, then I'll do a more thorough CV exam, but otherwise listening while sitting is sufficient for me.

I also can't say that I am an expert on vision and prescribing glasses, so I rec my pts see an eye doctor for that.

Also, there are lots of things you cover in a Complete Physical other than the exam. There is a whole host of recs based on ages. Example everyone needs a colonoscopy when they are 50, mammograms at 40, etc. This keeps you busy enough and a checklist on your well exam forms can really help you keep track of it.

Hope this helps!

Karla

 

[Faebinder]

The most invaluble thing from a yearly exam I would say is the blood work... to have a series of blood work on a person is very important.

 

[mamadoc]

The most invaluble thing from a yearly exam I would say is the blood work... to have a series of blood work on a person is very important.

Faebinder, I am pretty sure you're not a family doctor! I tell all my patients that the most important part of the exam is where we sit and talk - reviewing their health history, their health habits, immunizations, family history, etc. etc. etc. Please do not think that healthy twentysomethings need yearly blood work. (One can readily argue that healthy twentysomethings don't even need yearly exams for the most part - I am racking my brain to think of anything besides the Pap smear that really should be tracked yearly in this population. Maybe KentW will chime in....)

On a healthy mid-20s person whose family history doesn't have any screaming red flags (e.g. sibs or parents with diabetes or heart disease), I'll make sure to check their cholesterol at least once during that **decade** (and if elevated, will of course continue to follow up). But that's about it - any other labs I draw will be based on what I hear from the person, not just for "screening" in a random way. I can't think of any reason why it would be important to have an ever-thickening file of normal blood work on someone. If they develop a problem, you'll get the appropriate blood work for it and follow it from there.

Check out the U.S. Preventive Services Task Force recommendationshere

 

[Faebinder]

Faebinder, I am pretty sure you're not a family doctor! I tell all my patients that the most important part of the exam is where we sit and talk - reviewing their health history, their health habits, immunizations, family history, etc. etc. etc. Please do not think that healthy twentysomethings need yearly blood work. (One can readily argue that healthy twentysomethings don't even need yearly exams for the most part - I am racking my brain to think of anything besides the Pap smear that really should be tracked yearly in this population. Maybe KentW will chime in....)

On a healthy mid-20s person whose family history doesn't have any screaming red flags (e.g. sibs or parents with diabetes or heart disease), I'll make sure to check their cholesterol at least once during that **decade** (and if elevated, will of course continue to follow up). But that's about it - any other labs I draw will be based on what I hear from the person, not just for "screening" in a random way. I can't think of any reason why it would be important to have an ever-thickening file of normal blood work on someone. If they develop a problem, you'll get the appropriate blood work for it and follow it from there.

Check out the U.S. Preventive Services Task Force recommendationshere

Nope.. definitely not an FP. So I definitely don't value my opinion as much as yours.... And you are right, labs don't make the doctor but I still find early labs to be valuble.

 

[raptor5]

Nope.. definitely not an FP. So I definitely don't value my opinion as much as yours.... And you are right, labs don't make the doctor but I still find early labs to be valuble.

Why? Labs confirm suspicions. What labs are you talking about? What are your suspicions in a healthy person in their 20's on no meds? Might as well get an ANA, ANCA, CEA, PSA, AFP, S-100, and full body CT while your wasting money.

 

[Faebinder]

On the floor, this seems to be a continuous issue. The person is admitted and has slightly low Hemoglobin and sometimes slightly low hemocrit or slightly high.... The patient didn't come in for bleeding or blood problems but the next question is should we look into this or is this the norm for this person (one of those 5% outside the curve) or an artifact of the lab. On the floor we don't have previous lab work (sometimes they do if the person was admitted before) and so I'm unsure to what the norm is for the person.

This is my feelings about this but as I stated... I'm not an FP but I feel that first time CBC, CMP (and sometimes Cholestrol) on anyone seen for the first time is justified.

(I agree PSA, ANA etc etc etc is insane to do as routine... especially considering that the laws of statistics will give you back 5% positive simply due to the way the curves were made when they put the ranges on the lab numbers.)

 

[raptor5]

Fair enough. I don't agree though. You don't know if this person will ever be admitted while you are her/his primary care doc. A baseline from 5 years ago is useless especially in a healthy individual. Why get the tests when they are healthy, sooner or later they will have a condition that will warrant them. So what if something is low or high normal, your not treating lab results your treating the person and the dz. I can agree that it would be nice to have accurate up to date lab results for comparison but I do not think it is a wise use of healthcare dollars or that valuable when in play.

 

[12R34Y]

Yeah, routine labs like CBC, chem profiles, etc....most definately aren't necessary if you don't have any health problems or complaints. You'll just find an occasional wierd lab value that has no clinical significance.

My PCP checks a lipid profile and fasting glucose. that's it. Because that's what I request. I have borderline high cholesterol and have a history of type II diabetes.

I have him cancel the routine CBC< chem, UA etc...that he always orders and just get my lipids and a sugar.

cheaper as well.

later

 

[deleted87716]

My PCP checks a lipid profile and fasting glucose. that's it. Because that's what I request. I have borderline high cholesterol and have a history of type II diabetes.

I have him cancel the routine CBC< chem, UA etc...that he always orders and just get my lipids and a sugar.

If you're diabetic, you should let him order the chem panel and urine. You're making a mistake by canceling them, and he's making a mistake by letting you. That's all I'm going to say. There is plenty of information out there that's readily available concerning what needs to be done when you're diabetic. I should add that if any patient of mine routinely "cancelled" lab work that I ordered, they'd be finding themselves a new doctor.

As for the aforementioned presumably healthy young female, again...I'd probably just order a CBC (to rule out treatable anemia in a normally-menstruating female), a U/A, a lipid profile, and a fasting glucose. I'd do this every 3-5 years. She needs an annual Pap. That's pretty much it, unless something crops up.

 

[RuralMedicine]

If you're diabetic, you should let him order the chem panel and urine. You're making a mistake by canceling them, and he's making a mistake by letting you. That's all I'm going to say. There is plenty of information out there that's readily available concerning what needs to be done when you're diabetic. I should add that if any patient of mine routinely "cancelled" lab work that I ordered, they'd be finding themselves a new doctor.

As for the aforementioned presumably healthy young female, again...I'd probably just order a CBC (to rule out treatable anemia in a normally-menstruating female), a U/A, a lipid profile, and a fasting glucose. I'd do this every 3-5 years. She needs an annual Pap. That's pretty much it, unless something crops up.

I agree that routine annual labs in healthy young adults not on medication makes little sense. (I often end up getting initial labs because they are on medicine for HTN, are depressed(so R/O organic causes) etc, etc). Your initial pass labs seem reasonable although I will often do a fasting CMP (you have your baseline LFTs if you end up with an LDL of 160+--too common in my "healthy" patients and our lab charges the same amount to run a fasting glucose as they do to do the whole CMP).

12R34Y-You really should be letting your PCP at least check BMP, Glycated Hemoglobin, (often elevated in type II DM even with normal fasting glucose) and urine protein:creatinine and urine for microalbumin. Perhaps discuss the rationale behind his/her recommended labs at the next visit.

 

[deleted87716]

I agree that routine annual labs in healthy young adults not on medication makes little sense.

Many of them expect it, though. And if they have insurance that covers it, they usually demand it.

 

[lilnoelle]

I am a 25 year old female on no medication with good family history. I had a pap last September with a 6 week post partum check up.
I have been led to believe that having a yearly physical was a good preventative medicine tool and so have had them nearly every year since I was little. This year was mostly bothersome because I had to drag my two children a long, which was a nuisance, and the physical itself was so short (although the wait in the office was rather long) I didn't intentionally hide anything from the doctor, but didn't have any written down questions so I forgot to ask about a couple of moles on my back that I wanted to check out.

Apparently the doc did everything that was needed, but that I, with my limited knowledge, don't realize all the information she could know with the checkup she did.