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When to have that physical

Nation's Business, April, 1995 by Peter Weaver

Managing well includes managing your own health; here is advice to help you do that better.

With so many quick and painless tests available to check for specific medical problems, it's easy to forget about having a comprehensive, head-to-toe physical exam. Indeed, many doctors recommend periodic tests for certain conditions at various times, depending on the patient's age, sex, occupation, and marital status. But most doctors still recommend a full physical at regular intervals.

"A lot depends on individual risk factors and family health history," says Dr. Richard Roberts, associate professor of family medicine and practice at the University of Wisconsin-Madison Medical School.

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Roberts says low-risk people should be examined every five years through their 30s, every two to three years in their 40s, every year or two through their 50s, and annually after age 60. Higher-risk patients--such as clear candidates for heart disease, stroke, or cancer--should be checked more frequently, he adds.

Dr. Paula Dewley, who practices internal medicine in Mayfield Heights, Ohio, favors annual checkups for everyone over 50. "So many different things can happen after age 50--osteoporosis in women, prostate cancer in men, heart problems for men and women." And those under 507 "It depends on the person," she says.

According to guidelines published by the American Academy of Family Physicians, a good physical should include not only an examination of your body but also a patient and family history (including diet, exercise, alcohol and tobacco use, and sexual practices). Height, weight, and blood pressure should be monitored regularly.

"Getting accurate height measurements," says Dr. Kathleen Weaver of Portland, Ore., president of the American Society of Internal Medicine, "is especially important for older women because a slight shrinkage in height might be an early sign of osteoporosis"--bone loss that often sets in after menopause.

Weaver also urges women to have a Pap smear and a breast exam every year. After age 40, women should have a mammogram every other year, and after age 50, every year.

For men, Roberts recommends an annual digital rectal exam after age 40 for prostate and rectal cancer. The American Cancer Society recommends adding a PSA (prostate sensitive antigen) blood test with the annual rectal exam after age 50. The PSA test is "something you should talk to your doctor about," Roberts says. One problem with PSAs, he explains, "is that they sometimes come up with false positives or false negatives."

Colon cancer is another potential risk requiring periodic checks. "Around age 45, it's a good idea to have an occult blood [stool] test and flexible sigmoidoscopy," says Dr. Gabe Mirkin, publisher of the Mirkin Report, a health-care newsletter based in Silver Spring, Md. After that, if there are no symptoms, he advises, "you can have the tests done every five years or so."

The American Academy of Family Physicians recommends a total blood-cholesterol test with every physical exam. "Anything above 220 milligrams [per deciliter] should be checked at least once a year," says Jack Kalberer, a coordinator for disease prevention at the National Institutes of Health, in Bethesda, Md.

An area often overlooked is one's skin. "I always look at a patient's skin," says Weaver, "especially in areas they're not able to inspect, to see if there are any cancerous or precancerous lesions, such as funny-looking moles with irregular borders or red, scaly areas that don't seem to go away." If there is any doubt, a visit to a dermatologist is in order.

If you think your doctor may be ordering too many tests, question the need before approving them, says the People's Medical Society, a consumer group based in Allentown, Pa. You can ask, for example, if the screening is being conducted because you are a high-risk patient. Find out what the test is supposed to achieve and how reliable it is.

Moreover, Kalberer, a physiologist and an expert in preventive medicine, and others think doctors and patients should engage in "more talking and less testing." Many agree that talking about what's going on in a patient's life is important. "You should be able to talk freely with your doctor," Kalberer says, "about such things as a death in the family, depression, your sex life, how you're handling stress, whatever seems to be bothering you."

During the one-on-one talk, patients can learn how to do their own monthly checkups at home, such as looking for suspicious lumps in breasts or on testicles, and monitoring one's skin for possible early signs of cancer.

Doctors warn against commercially available self-tests because results are not always accurate and can be "needlessly frightening" or create a "false sense of security," says Mirkin.

Most important in the patient-physician talk, says Weaver, is the chance to change a patient's behavior: "If I can get someone to quit smoking, reduce the fat in their diet, do more exercise, and use the seat belt in their car, I can do more for them than I can with all the tests combined."

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When to have that physical

Nation's Business, April, 1995 by Peter Weaver

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