The Must-Have Annual Physical: What to Expect
The kids are back in school, the weather is getting cooler and pumpkins are on display at grocery stores. With the calendar year three quarters of the way complete, what better time to review your personal “to do” list and take care of matters that you may have been putting off … like getting an annual check-up?
Primary care physicians view the annual check-up as an important way to keep their patients healthy.
Benjamin Caplan, MD, a family medicine physician at Beth Israel Deaconess HealthCare-Needham Heights, not only uses this visit to perform required tests and labs, but also as an opportunity to connect with his patients and work on a plan for keeping them healthy over the next year.
“I tend to use the visit as an anniversary reminder to reopen discussion of how patients can maintain good health, to help remind them of long-term goals, and to encourage patients to give a fresh start for things they may want to work on,” says Caplan.
What can a patient expect at an annual check-up?
“Well, it actually varies widely depending on the patient and the physician,” Caplan says.
Taking vital signs (heartbeat, breathing rate, temperature blood pressure), monitoring weight, checking skin for abnormalities and taking blood to check things like cholesterol and sugar levels are commonly part of the annual visit. Age and gender of the patient also dictate what other tests may be necessary. For example, depending on their age and history, men could also receive a prostate exam, EKG to check for heart issues, or an abdominal ultrasound for those who smoke or used to smoke.
At the annual check-up, patients can expect to spend around 30 minutes with their physician, but that timeframe is not set in stone.
“For a new visit, the amount of time I spend usually depends on the complexity of the patient,” Caplan says. “I schedule annual physical exams for 30 minutes, but they almost always end up being 45 minutes. I want to be sure my patients are satisfied with the experience and get all of their questions answered.”
To make the best of your annual physical, go to the appointment as prepared as possible. Make a list of questions you may have and be prepared to discuss your and your family’s medical history. The more information patients can bring to their appointment, particularly if it’s the first visit with a new doctor, the better.
“The more organized a patient can be, the better their visits,” Caplan says. “I love when patients bring lists. When there’s a list, I know exactly what the patient is looking for and I can make sure that we discuss everything and answer all questions.”
Caplan suggests that patients also bring a list of medications they’re taking, as well as supplements, vitamins, minerals and any other over-the-counter medicines or pills. He says that most family doctors are also educated in alternative medicine, and can be proactive about finding any potential drug interactions that over-the-counter alternative supplements can have on health.
For women, the annual gynecological Pap test and breast exam can help find abnormalities with the cervix, ovaries and breasts. While primary care physicians can offer these services, some women prefer to have them done by an OB/GYN.
New guidelines for Pap tests have recently been published by the U.S. Preventive Services Task Force (USPSTF), a group of independent health experts assembled by the Department of Health and Human Services. The USPSTF recommends Pap tests for women ages 21 to 65 once every three years instead of every year. They do not recommend screening for women under 21 or over 65.
Because the USPSTF guidelines are not mandatory and most primary care physicians and OB/GYNs find value in the annual exam, they still prefer to screen women every year.
“The understanding of the causes of cervical cancer has evolved over the past few decades,” says Renee Goldberg, MD, an OB/GYN at Beth Israel Deaconess Hospital-Needham. “We know now that cervical cancer is caused by HPV and that it takes 10 to 20 years from infection to develop cervical cancer. These guidelines help prevent unnecessary procedures and surgery. Patients still need to come for their regular GYN exam yearly to screen for other gynecologic problems and cancers, and with proper education, my patients have readily accepted the new guidelines and are a bit relieved not to have the yearly pap."
Additionally, the American Cancer Society continues to recommend annual mammography screening for all healthy women beginning at age 40.
People aged 65 and over, especially those with ongoing medical conditions, may consider having a geriatrician provide their primary care.
“Most older people can be successfully cared for by their regular doctors,” says Suzanne Salamon, MD (below right, with a patient), a geriatrician in the Senior Health clinic at Beth Israel Deaconess Medical Center. “Geriatricians specialize in the issues which aging can bring, such as memory loss, frailty, weight loss, issues with balance, medication management, or a combination of these problems.”
The Senior Health clinic sees patients who range in age from 65 to 104, with most patients being in their early 80s.
Physicians in the Division of Gerontology at BIDMC recommend annual physicals for their patients. But for patients who have difficulty getting to the doctor’s office because of their age, patients will get screened on an ongoing basis, whenever they can come to the office.
For her patients, Dr. Salamon recommends bringing not just a list of their medications to their appointment, but their actual medication bottles with the pills in them.
“By bringing the actual bottles, we can be sure they are not taking duplicate medications, check to see if the doses on the bottles match the doses on their list, and actually watch how they open the medicine bottles and demonstrate for us how they take their pills,” Dr. Salamon says.
She also asks her patients to bring a list of any questions they may have. Finally, if a patient has memory issues, she suggests a family member, friend or geriatric care manager accompany the patient to the visit or participate via telephone.
Depending on age and medical history, eye examinations are recommended every one to three years to test for glaucoma, cataracts or other problems that the patient may not be aware of. School-aged children (around five years old) and people over age 60 should have annual examinations.
“Young children and adults over age 60 tend to experience the most changes with their eyesight in short periods of time,” says Paul Murray, OD, an optometrist in the Longwood Medical Eye Center at BIDMC.
According to Murray, if an eye problem such as strabismus (“crossed eyes”), poor vision, or squinting is suspected in children younger than age five, then the child should be seen at that time. If there is a family history of Amblyopia (“lazy eye”), an exam at age two or three is fairly common.
For adults, difficulty reading street signs or the menu in a dimly lit restaurant aren’t the only things optometrists look for during an eye exam.
“It’s not just about whether or not a person needs glasses to see better,” Murray says. “Almost any disease of the body can have eye conditions associated with it. Diabetes is probably the most common systemic disease with associated eye problems, but multiple sclerosis, hypertension, thyroid disease, arthritis and others can all present issues in the eye.”
Murray also points out that cataracts are very common in people over 60 and can be corrected with surgery by an ophthalmologist. Glaucoma can affect people of all ages, but is most common after age 60 and is treatable with eye drops.
“Just because these conditions are treatable doesn’t mean we should ignore preventative eye health,” Murray continues. “They’re just as important as annual physicals with your primary care physician.”
So with thoughts running through your head about how your kids are doing in school, how much Halloween candy you’ll need to buy next month, and when your local cafés will start serving pumpkin coffee, lattes, muffins and the like (probably now), don’t forget about that annual check-up. It will be over and done with before you can say, “I’ll have a medium, half-caf, skinny, no foam, extra shot, pumpkin cappuccino, please.”
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care and before starting any exercise program, consult your doctor.