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Check Your Health is a web-only feature being offered monthly by The Cheshire Herald. Each month, a professional from MidState Medical Center will offer advice on a different issue pertaining to health.
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 twenties, thirties or even forties 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 3 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.
Expect a thorough 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.
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
A team to count on
The wellness and preventive visit ultimately is a line of defense set up to promote health, and prevent illnesses. We are fortunate, at a time when so many people are seeking good, regular primary care, to have highly trained advanced practice nurses (APRNs) and Physician Assistants (PA’s) who are well trained to perform the wellness and preventive exam services. As the physician, my role continues to be seeing and examining patients, supervising a great team of medical professionals, and building partnerships with my patients based on their trust in our ability to provide the highest level of primary care.
Dr. Erin Cardon,
Hartford HealthCare Medical Group’s Women’s Primary Care