By Dr. Moss Linder, Grace Cottage Family Health
What is the benefit of an annual physical? What’s included, and why is it so important?
October is a good time for considering these questions because it’s Health Literacy Month and the month when we celebrate National Primary Care Week.
In this column, I would like to focus on answering these questions.
You may have heard the annual physical referred to as a wellness check, a periodic health exam, a routine physical exam, or a preventative care visit. Whatever you call it, it’s important. Rather than focusing on a particular problem and treating it, the annual physical gives you a chance to assess your overall health and to get guidance for next steps.
The physical generally takes 40 minutes and includes lots of provider-patient conversation. We use our observations and conversation to make suggestions for follow-up tests, based on evidenced-based guidelines from advisory groups such as the United States Preventative Services Task Force, the Centers for Disease Control, the American Heart Association, or the American College of Cardiology.
There is lots of advice and guidance bandied about in the media or online these days. In fact, the amount and volume of suggestions we hear seems to grow daily. It can be confusing, not only for patients but for providers as well, so at Grace Cottage, we rely on recommendations based on evidence-based guidelines from groups like those listed above.
Evidence-based guidelines are recommendations intended to optimize patient care. These guidelines are developed after a rigorous and transparent review of the best available scientific evidence, as well as an assessment of the benefits and harms of different care options.
We then review these guidelines with patients, explaining the different choices available to them, so they can make decisions based on reliable information as well as their own personal health and preferences.
Guidelines can change over time as we learn new things. So, moving forward with advice from your provider is based upon what we hope is shared decision making. We, as medical providers, counsel you about how to lead a healthy lifestyle, how to prevent communicable diseases, and how to prevent or make early detection of cancer.
Ultimately, though, you the patient are in control. You can take things into consideration and then decide what to do. You may not always agree with what your doctor/medical provider suggests. That’s okay. Patients often say they want to move forward with some things, not do certain things, and take some time to ponder other recommendations.
The most important thing is that you understand the guidance and then make your best decision based upon the advice and its importance to you.
At your physical, you will have your blood pressure, temperature, blood-oxygen level, pulse rate, height, and weight measured. The provider will also examine the head and neck, chest, abdomen, and skin. Typically, we also review immunization recommendations; blood pressure history; use of substances including alcohol, tobacco and others; cancer screenings recommended based upon age and gender; and a review of advance directives.
There is also a general review of systems. For instance, are you having headaches, are you having any problems swallowing, do you have chest pain or shortness of breath if you exert yourself, are your bowel movements normal for you, do you have any urinary issues, are you having any issues or concerns regarding your mental health?
In addition, we also ask if you are following any special dietary regimen, how you stay physically active, and how things are going at home and at work, if you are working. We’ll also ask if you are having any issues with housing or food insecurity. As you can imagine, answering any one of these questions could open up other issues and concerns.
One exception to note: interestingly and surprisingly to me when I learned this, the Medicare Wellness visit—the wellness exam recommended annually and covered yearly by Medicare—does not specifically include this full range of physical examination. The Medicare Wellness visit is limited to targeted assessments and preventative planning.
Typically, during a physical or Medicare Wellness visit, we do not talk in-depth about your chronic medical problems such as diabetes, hypertension, heart disease, chronic pain etc. Those topics deserve visits outside of the general wellness examination, with time specifically dedicated to the issue. Having said that, there is naturally some overlap between someone’s ongoing medical problems and a general wellness exam, so some discussion may occur.
These annual visits are a time to design a comprehensive plan to maintain and improve your health. It is also an essential part of developing an excellent, trusting, and productive patient-provider relationship.
