By Dr. David Lipschitz
If you are over 50, it is time to have an annual physical. At an earlier age, provided there are no known medical conditions, a screening every two to three years may be adequate. Not every 50-year-old receives an annual physical, and when they do, they often receive more testing than needed. It is important, therefore, that everyone know what should and should not be included in the examination.
An annual physical includes a careful history and physical examination during which any problems and complaints are documented, as is a history of hospitalizations, surgeries, allergies, medical conditions and medications.
A family history is needed to determine if there is an increased risk of heart disease, cancer, diabetes or Alzheimer’s, as well as a sociological assessment (marriage, education, religious preferences, habits). The examination seeks to gauge high blood pressure and heart, lung, abdominal, vascular and neurological health.
An assessment of mood is important and if older, a screening test for memory loss may be done. Calculating the body mass index identifies obesity. No examination is complete without counseling on how to stay healthy and manage obesity. A referral to smoking cessation programs can also be recommended.
Perhaps the most confusing and over-utilized portion of the annual physical is the screening tests needed to exclude or prevent disease. Most recommendations come from the United States Preventive Services Task Force. Its approach is based on a meticulous analysis of all available scientific information by a panel of experts in public health.
To prevent heart disease, high blood pressure is measured two to three times annually and cholesterol levels in the blood should be evaluated every two to three years after age 50. Electrocardiograms, stress tests or CT scans of the heart should not be done solely as screening tests in healthy individuals. Blood tests are obtained to evaluate liver, kidney and thyroid function and to exclude anemia. Unless a medical condition warrants it, there is no need to perform screening tests every year.
The preventive task force only recommends screening for diabetes in healthy patients with elevated blood pressure. However, most other groups suggest that screening should be obtained every two to three years in obese individuals or those with a family history of diabetes.
Most contentious are cancer screening recommendations. The task force recommends mammograms every two years for women in the 50-75 age group. Mammograms should be done annually for women 40 to 50, only if there is significant increased risk. A routine pap smear to screen for the human papillomavirus and cervical cancer should be done every three years in sexually active women up to age 65. The task force states that screening for ovarian or bladder cancer is of no proven value.
For men and women, a colonoscopy should be done at age 50 and every five years thereafter until age 75, and screening the stool for microscopic amounts of blood should be done annually. Of all the screening tests available, those to identify colorectal cancer are the most effective. Recently, the task force recommended against the PSA (prostate-specific antigen) blood test to screen for prostate cancer in healthy men of any age. Like the mammogram, this remains contentious with many experts recommending that prudent use of this test continue.
As part of the annual physical examination, vaccinations must be reviewed. Everyone over age 50 should be vaccinated against shingles and over age 65 the pneumococcal vaccination should be given. Flu vaccination is required annually.
Strive to be as educated as possible about what it takes to stay healthy and prevent disease. Go into the doctor’s office armed with information so that you are able to ask the necessary questions to get the best care possible.