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Who Needs An Annual Physical/Wellness Exam?

July 06, 2016

By Dr. Erin Cardon

Most Americans today recognize the value of partnering with a good primary care provider (PCP) as an effective preventive measure against potential disease. This relationship begins with a wellness or preventive exam, what some call their “yearly physical.”

During the first of such visits, a complete patient and family medical history is taken and discussed with the patient. A detailed exam follows, which will be performed yearly from then on. Over time, a partnership develops between doctor and patient with the shared goal of ensuring optimum patient health. From my perspective as a PCP for adults, this goal is best achieved by not only applying my medical skills and expertise but also by building my patient’s trust.

Who should have the annual visit?

It might be best to start with who doesn’t need to schedule wellness or preventive exams. Healthy individuals in their 20s, 30s or even 40s who do not have a family history of serious illnesses such as breast, gynecological, colon or lung cancer do not necessarily require this routine yearly checkup, and may generally be seen at three-year intervals. The standard of when wellness and preventive visits should routinely begin for healthy men and women is around age 50. In general, women should have an annual gynecological exam with Pap smear beginning at age 21.

It is important to differentiate between disease management and preventive care. For individuals with conditions such as obesity, diabetes, hypertension, etc., the wellness visit offers opportunity for monitoring, observing changes and counseling. As such, it can be seen as part of disease management. These patients, whether young or old, should be scheduled for this yearly visit.

But let’s say a patient presents for their wellness visit without signs of anything. That’s when we’re providing preventive services. If, however, that same patient says, “I have a cough, and I’ve had it for three months,” we are now in the realm of dealing with a symptom of disease and we move beyond preventive services. Further investigation and treatment may be required, either by the PCP, or in consultation with a specialist.

The Process

In my practice, a comprehensive checklist of services is performed during the wellness or preventive visit. This includes:

• Yearly updating of immunizations as well as counseling on the importance of receiving these immunizations
• Taking vital signs and blood pressure; monitoring of hypertension (high blood pressure) and counseling on ways to decrease it
• Obesity screening with BMI (height-to-weight measurement); dietary counseling and diabetes screening where necessary
• Discussing use of alcohol and tobacco
• Cholesterol screening: blood test results discussed
• Discussion of screening for breast and cervical cancer (for women) and prostate cancer (for men)
• Discussion of colon cancer screening, with colonoscopy recommended every ten years for healthy patients beginning at 50, depending on family history
• Discussion of osteoporosis screening
• Observing/discussing depression, anxiety, domestic abuse or other psychiatric concerns
• Discussion of screening for sexually transmitted diseases (gonorrhea, HPV, HIV, etc)

While we regularly order screening tests for the above-mentioned diseases, patients are often under the impression that more tests exist that they should have. In fact, there are best practice guidelines published by our medical societies that determine the benefits of certain screening tests.  Just because a test exists, does not mean it should be utilized for screening.  False positive results for many tests, such as the ovarian blood test (CA-125), often lead to unnecessary, expensive treatment with potential physical harm. These tests would not be recommended.

‘Hands On’

The final but equally important part of the wellness and preventive exam is the physical. Going from head to toe, the physician closely examines the patient to evaluate the health of the body’s organs and systems, and to catch any problems not yet detected or mentioned by the patient. Again, the checklist is extensive:

• Examining the eyes, ears, mouth and throat
• Feeling the neck, thyroid and lymph nodes for lumps or swelling
• Listening to the heart and the lungs, and feeling the arterial pulse points in the neck, and all extremities
• Examining the breast tissue in both women and men
• Feeling the liver and spleen
• For women, performing a pelvic exam; and for men, a genital and prostate exam
• Performing a rectal exam and fecal test for patients not up-to-date on their colonoscopy
• Examining the skin for signs of cancer

Dr. Erin Cardon practices with Hartford HealthCare Medical Group’s Primary Care office located at 1781 Highland Ave. in Cheshire. To find a physician or schedule an appointment, please visit the Hartford HealthCare Medical Group website.