"The Value of Physical Exams" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

August 1, 2008 - How often should you see your physician? What should be done to keep you in good health? These are two excellent questions that have been addressed by multiple studies and summarized by the National Guideline Clearinghouse on their website: http://www.guideline.gov/

The results are not necessarily what one would think, or what is commonly being done. Evidence-based medicine is a newer method of showing, by the use of objective data, what works and what doesn't. The recommendations are segregated into three age groups: 19-39, 40-64, and over 65.

The following topics are labeled “must be covered” at every opportunity because they have been proven to make a difference: aspirin chemoprophylaxis counseling, breast cancer screening, calcium chemoprophylaxis counseling, cervical cancer screening, chlamydia screening, colorectal cancer screening, hypertension screening, influenza immunization, lipid screening, pneumococcal immunization, problem drinking screening and brief counseling, tobacco use screening and brief intervention, and vision screening. Chemoprophylaxis is using a medicine to prevent future illnesses.

Most of these are age specific and some are gender specific. For example, vision screening is for the over 65 age group, while calcium chemoprophylaxis counseling is recommended for all females 19 and older. Tobacco use and problem drinking start with the younger group when it is easier to avoid an addiction or risky behavior.

Depending on the past history of the patient, other measures may not be necessary every year. For example, three negative Pap smears over a five-year period reduce the need to have a Pap smear to every three years. These are recommendations that most but not all gynecologists agree with currently.

The next grouping, labeled “should be covered” include: abdominal aneurysm screening for over 65 male smokers, depression screening at all ages, folic acid for women who may become pregnant, hearing tests, hepatitis B, herpes zoster, human papillomavirus (which is a virus young women may get from sexual activity), polio, diphtheria, pertussis, tetanus, varicella (chicken pox), measles vaccinations as appropriate for age/sex, as well as obesity and osteoporosis screening.

There are also some things that have been done for decades without showing any evidence they are helpful (they won't hurt but do use up costly resources) which include: blood chemistry panels, CA 125 which is a test for some forms of cancer and ultrasound (for ovarian cancer screening), coronary heart disease routine testing, diabetes routine testing, hemoglobin/hematocrit (for anemia screening), thyroid stimulating hormone (TSH)/thyroxine (for hypothyroidism screening), tuberculin skin testing, and urinalysis.

Having a precise annual time for a “well patient” visit with your physician makes sense . . . much the same way babies are scheduled for “well baby” checks. These visits set aside time with specific expectations that the “must be covered” and “should be covered” areas are completed. When a patient sees a physician for a specific complaint there may not be time to focus on the recommendations which have been shown to make a difference in one's health.

Take care of yourself this summer. See your physician for a check-up that includes everything appropriate for you. As Ben Franklin wisely stated, “An ounce of prevention is worth a pound of cure.”

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.