Most patients visit the doctor’s office for acute problems like respiratory infections, injury or recent illness. Other visits are for management of chronic problems like hypertension, diabetes, heart and lung disease.
In contrast, the physical exam is a planned visit, usually on a yearly or bi-yearly basis. It is a more comprehensive visit in which a detailed history is obtained, a complete physical exam is done and a plan is created for future wellness.
The physical examination begins, most importantly, with a detailed history. This includes a list of current and past medical problems.
A list of all medications, both prescribed and over the counter, is obtained, as well as a list of all allergies. Family and social history are obtained.
The physical examination is essentially done from head to toe. Height and weight are reviewed. Vital signs are monitored closely to look for possible signs of elevated blood pressure or abnormal heart rate.
Depending on the age or existence of medical problems, an electrocardiogram might be added to the physical as a further diagnostic tool.
The final phase of the physical is creating a “wellness plan.” For a healthy patient, it might be just a reminder to eat properly, exercise, and wear seatbelts regularly.
Plans for smoking cessation or alcohol reduction are discussed with appropriate patients. In a southern climate there might be more discussion about hydration and sun block.
CDC recommendations are given regarding immunization, such as flu, tetanus and pneumonia vaccines. For age-appropriate patients, colonoscopy and other tests might be ordered.
For those who receive a Medicare Wellness Exam, more emphasis is placed on screening patients for depression, cognition and safety. Appropriate plans of action can be enacted depending on results of these screening tests.
Patients should include a yearly preventative exam in their schedules along with their dental and eye exam. Preventative health screenings can reduce healthcare costs by identifying potential concerns and developing a health plan before illness occurs. Prevention saves lives and lengthens the quality of our lives.
For patients traveling back and forth to the North or other areas, a preventative exam can provide continuity of care between the distant and local physician.
An update of medical problems and medications should be done at the wellness physical to ensure the patient has a non-conflicting plan of care.
Stephen H. Goldner, MD, FACP practices internal medicine with Medical Associates of Hilton Head. www.MedicalAssociatesof HH.com