The concept of the Physical exam has changed over the years as has the actual exam itself. An exam appropriate for a child or young adult would be totally inappropriate for an elderly adult as well as the difference in focus between men and women. Generally, unless there are underlying circumstances, the annual physical is no longer recommended in adults under 50. Instead, every decade up to age 50 then every 5 years until 65. After 65 the need for a physical is generally focused on chronic issues which require annual monitoring (heart disease, diabetes, respiratory, Autoimmune diseases) but those conditions found during the preceding years where both the progression of the disease as well as medications need to be examined or discussed. There is definitely no one size fits all.
Our goal is to make your life as undisrupted as possible. Once a condition is identified a plan of therapy is decided on with a course of medications and treatments are set with Annual Monitoring. The beautiful thing about modern technology is the accessibility and miniaturization of monitoring devices unheard of only 10 years ago. The patient can now be responsible to follow their blood pressure and the diabetic can constantly monitor blood sugars with abnormal results sent directly to the physician. But most importantly each regimen can be tailored to the patient giving them control of their health and not the constant overseeing by the physician.
It is important to get baseline labs with cholesterol, kidney function, blood pressure, liver function and such as these are all related to modifiable risk factors. Which means if anything is found abnormal; things such as lifestyle or medications can be used to change them. To bring them back into a normal range; but most importantly is to not get caught up chasing numbers. One of the best bits of advice I got from one of my Mentors was to; Always look at the patient. Don’t get caught up in numbers’. If you go chasing a single value that is out of range you will drag that poor patient down the rabbit hole starting a series of testing and then imaging ending up with invasive biopsies. You literally punched a hole in the patient for a piece of tissue just to see why a single lab value is different from the others. Statistically, normal values are based on a 95% standard deviation; which means that 1 in 20 values will be out of range. Check it again in six months and that Valium will be normal and another will be out of range. Chasing numbers in lunacy until you finally poke a hole in your patient looking for something “Wrong”. When in actuality it was the lunacy of you poking the hole on your patient in the first place. When in doubt, look at the patient. Are they fine? Good, then leave the punch biopsy in the case and just repeat the lab next year.
The bottom line is that the requirements for Physicals change with the years and with the individual patient. Look at the patient, Listen to them. Are they happy, How do they feel, how do they look? Give them good advice and not how they should live their life. A 280 pound physician has no credibility telling someone to lose weight. There’s not a single patient in the world who thinks smoking is good for them. I am a physician, not the God that created them who now sounds insulted that they didn’t change the oil on time. If they have high blood pressure and the medication is working then give it to them; not make them call back every month for a refill and demand they be seen. It just makes the physician look petty and Lord knows they don’t need any help with that. Voltaire said it best: “the role of the physician is to keep the patient in a good mood while nature does the healing”. Pretty good advice for the 17th century. Dr. Jonas Salk invented the Polio vaccine and then GAVE it to the world. Free. Well, that just won’t do; so Dr. Sabin invented one (no better, just used a needle instead of a sugar cube), but he charged money for it (well the company he worked for did). Your momma said you shouldn’t make impressions of people; but really, I have no doubt who was the better person here.
Find a physician you trust, who is reasonable, seems intelligent, listens, and most of all, his advice actually makes sense. Don’t be fooled by letters after their name and degrees (I have lots of them). My grandfather was a town Barber, and didn’t have a single letter after his name. But he was smart, liked people, gave good advice and cared about people. He wasn’t a doctor, but I’ll always remember that shank of horse tail he kept to sew up lacerations. In everything I do, I make sure to make him proud. That’s my measure of a good man and a good physician.
