By Dr. Isadore Rosenfeld
Published: July 29, 2007
A routine physical exam at regular intervals has many benefits, the most important of which is the early detection of disease. Many major killers—such as cancer, diabetes and high blood pressure—may be present for years before they cause any symptoms. Finding and treating them early enough can save your life.
Another reason to see your general internist—even when you’re feeling healthy—is to develop an ongoing relationship, so that he or she can better determine your specific risks and vulnerabilities as you grow older, then advise you about how to prolong and improve the quality of your life. Also, if and when you do get sick, you’re much better off being treated by a doctor who knows you—inside and out—especially in an emergency situation. That’s what the routine physical is really all about. I don’t know a single patient who has regretted the cost or inconvenience of having a checkup.
Still, many health insurers and even some doctors keep saying that a regular exam is not cost effective. It may not be “worth it” for them, but I couldn’t disagree more strongly with their assessment. I believe that a checkup should be available to every American man, woman and child—as it is in so many other developed countries.
What You Should Expect
Regular exams should begin early in life with a pediatrician. For an adult, the exam should include a detailed history, to which your doctor must take the time to listen. But first, start by filling out the medical-history questionnaire thoughtfully: It’s far more important than you think. Come prepared with a list of your own concerns and questions. Discuss them with your doctor, and don’t leave until they all have been answered to your satisfaction. Diagnoses often can be made from a patient’s own careful description of symptoms.
At every exam, the doctor should look at your skin, listen to your heart and lungs, feel your belly and take your blood pressure. He or she should always listen with a stethoscope to the arteries in your neck to detect the sound made when the carotid artery, which carries blood to the brain, has become narrowed; and use an ophthalmoscope to look into your eyes, because that’s the only place one can see your arteries.
The physical exam should be followed by a comprehensive blood analysis to check for sugar, cholesterol, liver and kidney function, anemia and any other disorders. A urine exam also is a must, along with a test for the presence of blood (not always obvious) in a stool sample. As of last year, the Centers for Disease Control and Prevention has recommended that blood tests for all adolescents and adults also include screening for HIV.
I no longer recommend a routine chest X-ray unless you’re coughing or have other chronic respiratory symptoms. However, I do advise an annual “helical” or spiral CT scan of the chest if you are now or have ever been a heavy smoker—even if you have no symptoms. I believe this new tool is the best way to detect lung cancer early enough to cure it.
The bottom line: Even if a physical exam is an out-of-pocket expense, get it done. There’s nothing more important.
Tests for every age
Regular exams should begin in childhood. Here is what I advise my own adult patients. These recommendations are not set in stone, and every doctor has his or her preferences.
In Your 30s
• I suggest a routine physical for both sexes every three years to check for the presence of heart disease, hypertension and cancer.
In Your 40s
• You should have a complete exam every two years. This is when a regular cholesterol test becomes essential.
• Men should have a digital rectal exam every year. Women should have an annual pelvic exam.
• Women without a family history of breast cancer should have a clinical breast exam yearly and a mammogram every one to two years.
• I recommend a routine electrocardiogram for both sexes beginning at age 40 and, for some, a stress test.
In Your 50s
• Men and women should have a checkup every year to detect such conditions as high blood pressure, arteriosclerosis (hardening of the arteries), cancer, diabetes, emphysema and chronic bronchitis, arthritis and any behavioral changes due to early memory loss or depression.
• A colorectal cancer test also is a must. I suggest a colonoscopy at age 50. If it is negative (without evidence of a tumor or polyps) and there is no family history of colon cancer, it need not be repeated for 10 years, unless you develop suspicious symptoms.
• Every man should have a yearly PSA blood test
to help detect prostate cancer. This test has limitations, and some doctors caution against relying on it. But, in my experience, it has been a useful indicator of possible cancer.
also recommend a yearly PSA blood test. , which may indicate prostate cancer. While some doctors caution against annual screenings, I consider elevated levels them an early marker of possible cancer.
This is controversial, but in my experience, the “velocity” with which the PSA rises from year to year is a useful indicator of prostate cancer).
overflow: You may have had none of these earlier in life, but this is when they are most apt to begin.
such as blood in the stool, changing bowel habits, or unexplained abdominal pain.
In Your 60s
• You should continue to visit your doctor yearly.
• Women who are past menopause are at increased risk for osteoporosis and should have a bone-density test at age 60. (Other significant risk factors are smoking, lack of exercise, or a family history of fractures.) Otherwise, this test can wait until you’re 65.
• Everyone age 65 or older should have their hearing and vision tested once a year.