Many experts question the value of a preventive health check-up. Some economists suggest that the cost is too high for the benefits gained. And some consumer advocates wonder why the items that are discussed and examined all at one time during the annual check-up can't just be spread out over the year in office visits that occur for other more specific reasons.
But I am a strong proponent of giving the annual check-up its own dedicated time. Everyone knows how little time doctors and patients have together already. When I see somebody for a specific reason, I usually use that entire visit for discussing that topic with the patient. I feel much more secure knowing that my patients and I have set aside time once a year to make sure we're proactively maintaining their good health, rather than just reacting and responding to problems as they occur.
What actually should happen at such a visit? The specific details depend on your age and health, but here are the basic ingredients.
History. I start by asking how you feel. Are there any new health problems or questions since we last got together? Is there anything else on your mind?
The next part of the history is an update on each of your previously known diagnoses. I want to know if they are all well controlled. If not, we need to make a plan to improve them. Each of your medications (prescription, over-the-counter, herbs, and supplements) should be reviewed, as well as your allergies.
Your lifestyle and habits should also be discussed, looking for any risk factors. Then I ask about family history -- tell me about any new health problems you've learned about for any blood relatives. Finally, I like to check your vaccination history and update any needed vaccines.
Physical exam. This starts with your vital signs, most importantly your weight, blood pressure, and pulse. We often measure your breathing rate and temperature, but these signs are usually less important for a routine check-up. Height becomes important later in life, as a way to screen for low bone density and other age-related problems.
After that, I quickly check all the body systems, paying special attention to any issues identified during the history. Starting between the ages of 40 and 50, an annual rectal exam is added to check for signs of colon cancer (in both men and women) or prostate cancer (in men only).
Tests. Younger and healthier people need few routine tests. Blood sugar and cholesterol levels should be measured periodically. Blood counts, electrolytes, kidney function, liver function, and urinalysis are often checked, but are generally unnecessary in healthy people under age 40 or so.
Special screening tests get added at certain ages, and need to be repeated at varying intervals. Among others, these might include mammography, PSA (an imperfect test to look for prostate cancer), colonoscopy, checking stool for blood, and a bone-density test.
Routine chest x-rays are almost never necessary. Periodic routine electrocardiograms (or EKG, a test that measures the electrical activity of the heart) rarely detect any problems, but are useful for providing a normal baseline in case of a problem in the future. I generally do not recommend a screening exercise stress test for people who are physically active with no symptoms. However, if you aren't very active and are at moderate or high risk for heart attack, it might be worth considering.
I believe there's just no substitute for patients and doctors seeing each other face-to-face periodically, when no specific health problem is bringing them together. This is how a doctor and patient establish the kind of trust and rapport that is critical to a successful health care relationship.
