As more of us get our COVID-19 vaccines in the coming months, we will see more people getting back to making appointments for routine physicals, or wellness visits. Here are some common questions you may have. Though I’ve been seeing patients in person throughout the pandemic for emergency concerns as well as annual physicals, many people have opted for telehealth check-in visits and are waiting for the in-person examination for some time in the spring or summer.
Do I really need an annual physical?
If you are over 50, probably yes. Though, there is debate in the medical community about this. Many feel that younger people with no ongoing health issues or symptoms can easily wait 2 years. Women, however, should get an annual checkup and pelvic exam with their gynecologist, or women’s health care provider, yearly. Though a pap smear, which screens for cervical cancer, is often a part of the annual exam, some women only need the pap smear every 3 years, but they still need their annual exam. It is good to establish a positive relationship with your provider and seeing them once a year can help foster that. Also, it gives the provider a chance to make sure the patient is keeping up on their preventive care.
Who can I see for this?
We do have a shortage of primary care physicians in the US and getting appointments can be a challenge. There are other medical professionals who are excellent choices for giving you your routine physical exam. Called advanced practice providers, these include:
- Doctor of Osteopathic Medicine (DO), whose training and residency is closely aligned with an MD’s.
- Nurse Practitioners (NP) – that would be me – have a nursing degree as well as advanced education, master’s degrees or doctorates as well as advanced clinical training and residencies in areas such as family medicine, internal medicine, emergency medicine, women’s health and pediatrics.
- Physician Assistants (PA)– usually involves a three-year master’s program with specialized coursework, as well as training in areas such as family medicine, internal medicine, emergency medicine, and pediatrics.
- Certified Nurse Midwives (CNM) – these are nurses who have a nursing degree as well as a master’s or doctorate and specialize in women’s health. They are credentialed and are able to deliver babies.
What should I bring to an annual physical exam?
Your Medical History
If you are starting with a new provider, this is number one. You will be asked to fill out a form, so do a little homework first so you have all the information you will need with you. Make a list of:
- Any previous diagnoses you have received such as:
- High Blood Pressure
- Cancers (including skin)
- Heart disease
- Thyroid disorders
- Any surgeries – including dental
- All medications – names and dosages, plus any herbs and supplements. (Taking a phone photo of the bottle labels works)
- Vaccinations taken – tetanus, flu, shingles, pneumonia
- Allergies or allergic reactions – to medications, food, environment, vaccines
- Concussions or falls
- Any emergency visits or hospitalizations
Your Family Medical History
Health care providers like to know about the health of your parents, grandparents and even your aunts and uncles. Many of the illnesses above have a genetic component. For example, if I know a patient had a parent or sibling diagnosed with colon cancer before age 50, I would recommend they have an early colonoscopy and that they consider genetic testing. Many cancers seem unrelated, however, if there’s family member who has had prostate or pancreatic cancer other people in the family may be at higher risk for breast or ovarian cancer.
A Pen and Paper (or Device) for Notes
Even routine medical visits can be very stressful for some people, it is easy to have everything just go out of your head! Write down any questions you have, any symptoms you want to ask about. On that same paper you can write down the answers to your questions and then anything you want to remember about the exam when it is over. You can also make a note of recommended tests or screenings.
What questions will the healthcare provider ask me?
The visit will focus on preventive care if you don’t have any specific concerns. He or she will ask about your daily diet, your weight, if a risk, how much you exercise per week, how much alcohol you consume, and if you smoke. Many of us are embarrassed and worried that if we tell the truth, our providers will judge us or make us feel bad. I hope you have a provider who is non-judgmental and will help you learn about other healthier choices. Please, tell the truth, most providers are empathetic and know that we’re all human and doing our best. Don’t worry, it isn’t an interview for the Scouts.
We also know that many of us exaggerate a little when it comes to how much we exercise, use substances and drink. Once you sit down with them, you’ll be able to gauge quickly if this person is going to be judgmental or understanding. If they make you feel bad, find someone you can work with as a team, because if your health professional doesn’t know what’s really going on, they can’t do their job well. This also includes your mental health. An insightful practitioner who asks open-ended questions without shaming or blaming can hear and understand the struggles you might be dealing with and help you develop a plan to address those issues with compassion.
When it comes to a sexual history, this is one of the most private and personal aspects of your life. Most people want their provider to ask and are understandably not as comfortable bringing things up. Look for a provider who is “sex positive” and doesn’t judge or raise eyebrows, but who helps you feel comfortable talking, then who provides validation that your questions and concerns are normal, and also provides information that you can use.
What does the hands-on part include?
Typically, the provider will:
- check and record vital signs – blood pressure, pulse, and temperature
- listen to your heartbeat and breathing using a stethoscope
- use their hands to press on your neck, throat, and abdomen checking for sensitivity and abnormalities. And look inside your mouth and throat – say “Ahhhh.”
- check your reflexes using a tiny hammer to tap your knees, and have you push and flex your arms, hands, and feet to check for normal strength
- look over your skin for any unusual moles, lesions or spots
- for women, a breast and pelvic exam
- for men, checking the genitals, prostate, and for hernias
Will I have to have blood drawn?
Usually, healthcare providers will follow well-established guidelines on how often to ask you to have a blood test for several screenings such as:
- a complete blood count, or CBC, that determines if your blood cell counts are in the normal range for your age and gender
- a lipid panel, a blood test that measures your fats and fatty substances including cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)
- a basic metabolic panel, a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, and kidney function
- Thyroid screening
- Vitamin D levels
- Hemoglobin A1C – a diabetes screening test
Should I fast before my blood draw?
This varies. Many still advise patients to fast for 8–10 hours before a blood draw. Measurements of kidney, liver, and thyroid function, as well as blood counts, are not influenced by fasting. However, fasting is required before commonly ordered tests for glucose (blood sugar) and triglycerides (part of the cholesterol, or lipid, panel) for the best results.
What other tests will I need?
• After 40, it’s recommended that women have a mammogram every 1–2 years depending upon their personal risk factors.
• People over 50 need a screening colonoscopy. Any follow up tests depend upon what is found on the first colonoscopy.
• Women at midlife need a bone mineral density test every few years depending upon their personal risk factors
I hope this helps you prepare for your annual exam and please let me know if there’s something else you routinely have checked. Be well!