Your Doctor And You - Routine Or Non-Routine Visits?

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Your

Doctor And You – Routine Or Non-Routine Visits?

There are many misconceptions about what a

routine doctor's visit can accomplish and what its limitations may be. If

sudden death cannot be reliably predicted or prevented, what is the point of

seeing the doctor at all? It turns out that many conditions can be readily

detected or prevented, while others are simply beyond the limits of screening

tests or examination.

First, it matters whether the visit is truly

" routine, " meaning there are no symptoms and the person seeing the

doctor feels entirely well. On the other hand, if you set up the appointment to

evaluate a symptom, ongoing problem or concern, everything changes: The visit

is no longer " routine, " and what goes on in the office may be focused

on the complaints or medical conditions that you have.

Even in the absence of symptoms, many

physicians recommend routine, yearly doctor visits and physicals for adults of

all ages. Such visits actually have modest goals:

To ask about health problems and disease-prevention

measures. Even if it is not the reason

for the visit, routine questions about exercise, alcohol use, depression,

domestic abuse, and hearing problems, for example, may lead to treatments

or interventions that make major improvements in your health or quality of

life. Questions about smoke detectors, use of seat belts or a bicycle

helmet may be helpful to encourage some simple measures that can be

lifesaving. Finding out about past vaccinations and whether you are due

for boosters falls into this category.

To determine your risk of disease.

Before you develop symptoms of heart disease, osteoporosis or cancer (as

examples), your physician may uncover risk factors that lead to prevention

or earlier detection of disease. Examples include questions about family

history, smoking or exercise.

To examine you. It may

surprise you to learn that the demonstrated usefulness of a routine

physical examination is quite limited. For example, the American Academy of

Family Physicians (AAFP) recommends annual blood-pressure measurement and

periodic measurement of height and weight for all adults over 21, and

yearly breast examination for women aged 50 or older. There is little

evidence to support other routine examinations.

For example, the AAFP found inadequate evidence to recommend for or

against routine examination of the skin to detect skin cancer for persons

at " average " risk.

Keep in mind that even if you do have an abnormality

detected on physical examination, it is often of little importance. For

example, just as a freckle is technically not completely normal skin, minor

abnormalities are often detected that have no bearing on your health. A lipoma (a benign tumor made up largely of fat) can cause a

lump under the skin almost anywhere on the body; to be sure it’s not

something serious (like cancer), it may be important to have it removed, but an

examination that detects a lipoma is an example of

how an abnormal examination does not always mean you have a disease.

Necessary

Tests?

Some health-care providers routinely recommend

testing for people who are healthy at the time of their routine physical. In

fact, very few tests have been shown to be helpful. For example, for a healthy

woman over age 49, the AAFP recommends:

1. Regular screening tests for colon cancer (such as stool tests for

blood yearly and sigmoidoscopy, colonoscopy or barium

enemas periodically)

2. A Pap smear every one to three years (if she has ever been sexually

active and has a cervix)

3. Cholesterol measurement (with fasting lipid profile)

4. Mammography every one to two years

5. Visual testing (for the elderly)

That's it for people who report no health

problems, symptoms or risk factors for specific diseases. Based on the

evidence, other tests, such as EKGs, chest X-rays and blood tests are not

routinely recommended for anyone without symptoms or risk factors for a

particular illness.

Updating immunizations for the healthy adult

is also important. Tetanus and diphtheria vaccinations are recommended

routinely, with boosters every 10 years. Other vaccinations, including rubella,

hepatitis B and influenza may be appropriate for people in certain risk groups.

Putting

It All Together

Physicians integrate the information you

provide from your symptoms, past health problems, physical examination and

testing to detect disease or a risk of disease. If you feel well and have a

normal exam, it's likely you are healthy. Unfortunately, many conditions can

escape detection even with the best medical care. Sudden death may occur from

heart disease or a burst aneurysm (among other reasons) despite a recent normal

physical examination. It's a myth that a doctor can detect any health problem

you have just by examining you.

Your doctor may ask you

to come back yearly for a routine physical, but the real impact of such visits

may be limited. It's best not to rely on routine doctors' visits to provide a

guarantee of health. On the other hand, at your visit you may learn of risk factors

for disease you did not know you had, or discover that what you thought was

" just getting old " was really symptoms of arthritis or depression.

If you have symptoms or are worried about a

particular health issue, see your physician. But for truly routine visits,

understand that there are significant limitations for the detection of disease.

Unfortunately, a normal examination does not mean you are absolutely healthy

and, conversely, even if you have an abnormality on your examination or

testing, many findings turn out to be unimportant.

For many, having a routine physical helps

establish a relationship with their health-care providers, a process that can

come in handy if you ever are sick. Establishing a relationship with a

health-care provider may be among the best reasons to have a visit to your

doctor, even when you are feeling well.

Hugs,

Deanna