Dear Doctors: I am baffled that what used to be a thorough and comprehensive physical exam is now just a few questions, taking some vital signs and a few blood tests. No checking eyes, throat, glands or reflexes. No breast exam. Why has this changed?
Dear Reader: As surprising as it might seem, there are no official guidelines as to what annual physical exams should entail.
Some doctors and medical practices recently have moved away from offering patients a yearly checkup, prompted by studies that, in parsing large troves of health care data, have questioned the efficacy of this ritual.
But the annual physical exam continues to be an important part of our practices.
Absent the existence of guidelines for the annual physical, we can only discuss the specifics of our own approaches. We see it as an overall assessment of health and a chance to reconnect with the patient, an opportunity for patient and doctor to take stock of the previous year, assess any changes. set new goals and plan for the future.
In our practices, the annual exam begins with a review of the medical history, with any updates, including illnesses or injuries, vaccinations, medications prescribed by other doctors and mental health updates.
Family medical history, including new instances of diseases, get updated as well. Patients often deal with smaller, less pressing medical issues on their own, but adding information about these to their medical history can be important for future visits.
When we conduct a physical exam, we review blood pressure, heart rate, weight and body mass index. If there have been significant changes, we explore possible causes and discuss changes to diet, medication or behavior that might be needed.
We order a complete blood count, screenings for diabetes and cholesterol and tests that analyze liver, kidney and thyroid function. We also check vitamin D levels. We review those results, discuss them with the patient and offer mitigations if needed.
When screening tests such as mammograms, Pap smears and bone-density tests are called for, we recommend them. We also discuss the risks and benefits of the PSA test, which screens for prostate cancer. In keeping with newly updated guidelines, we recommend colon-cancer screening with a colonoscopy for patients 45 and older.
The information collected in an annual exam can help patients get a better understanding of their physical well-being. It also provides a baseline against which future changes or anomalies can be evaluated.
Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.
