by S. Todd Stolp
©September 2008
Many communities around the United States engage in an annual ritual called a “Health Fair.” While such events are organized as differently as the communities themselves, they often make certain screening tests available to participants and arrange for counselors to help people make some sense of our so-called “health care system.” However, one service that is not usually provided at Health Fairs is a physical examination, or “P.E.” Therefore, it might be worth pondering the value of a physical exam, and taking a moment to consider its place in the preventive services armamentarium.
The United States Preventive Services Task Force (USPSTF) is assigned the task of identifying those preventive services which are recommended for the general public. Several criteria are used to assess various preventive procedures to see if they make sense. Such criteria include the prevalence of the illness to be prevented, the effectiveness of the detection method, the disability caused by a preventable condition, the effectiveness of disease treatment once it (or the risk of it) is detected, possible negative consequences of a preventive intervention, and finally the cost of a preventive procedure, test or treatment. All of these criteria must be used to determine if a particular preventative step should be recommended to the public.
A physical examination requires that the patient bring his/her body to the care givers office. It also requires that the patient’s body be looked at, touched, moved, probed and scrutinized with fairly primitive lights and lenses. To do so requires that the patient remove his/her clothing. Otherwise, a P.E. might be accomplished simply by sending ones laundry and a photograph to the care givers office. Make a note of this when you are next seen for a routine physical examination.
It is now becoming popular, particularly in rural areas with limited availability of certain specialty physicians, for certain clinics to be conducted via camera, through something called “telemedicine.” The patient is observed through a video camera and the specialist is also visible on a monitor while the patient is interviewed and visually evaluated. Psychiatry and Dermatology are specialties for which this system sometimes works fairly well. However, “telemedicine” is not a satisfactory method of performing a routine P.E.
While asymptomatic discoveries during a P.E. are unusual, they do indeed occur. Whether it is a new heart murmur, an enlarged liver, a new spot on the skin or a lump that was previously undetected, with enough time in practice virtually every doctor has encountered such instances. While it is fairly uncommon for these findings to be life saving, it is not rare that these unexpected results enhance the quality of life of the patient. At the very least, such instances remind the patient that they are connected to the human race. These are examples of some of the benefits of a regular physical examination.
However, one of the less celebrated benefits of a P.E. is difficult to encapsulate and even more difficult to measure. This is the moment within the examination room when personal, confidential concerns and troubles that are encountered in every day life are shared. These generally are items that affect our health, but sometimes include things that we may not even recognize as health concerns. The treatments provided by the care giver may be nothing more than lending an ear, or answering questions tuned to the individual life of the patient. However it is this moment during the exam when issues affecting the quality of life can be addressed and reflected. It is an opportunity that the care giver recognizes as the greatest privilege of his/her profession, and it is an opportunity for the patient that should not be squandered.
The goal of a physical examination will be different, depending upon the age and/or developmental stage of the patient. During infancy, a P.E., traditionally called a “well-child exam,” is focused upon the developmental milestones, immunizations and parental education. A physical examination during the prepubescent years will raise new questions about relationships and body changes that may have the young persons head spinning. Young adulthood will touch on many issues that are forming lifelong objectives for the patient. More than 50% of adult patients will have complaints that revolve around happiness and satisfaction with their lives. And older patients often teach providers what to tell all the others.
While specific recommendations for a P.E. are not generally agreed upon by all specialty organizations, the following represents a recommended approximate frequency for routine physical exams for the general population based upon the current guidelines of the USPSTF and the California Child Health and Disability Prevention program (CHDP). You should consult your private care giver to determine the frequency of physical examination for your specific needs:
Infancy: At birth, age 2 weeks, 2 months, 4 months, 6 months, (9months), 12 months, 15 months, 18 months, 2 years
Childhood: At age 3 years, 4-5 years, 6-8 years, 9-12 years, 13-16 years, and 17-20 years
Adult: Every three years between 20-39 years of age
Every one to three years between 40-64 years of age
Senior: Every year from age 65 and older