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Is the Head-To-Toe Physical Exam Practically Worthless for Healthy Patients Who Are Asymptomatic?

As a health economist, I try to keep up with the latest trends in health insurance. One trend I have found is that consumers can now buy short-term health insurance policies that will pay for a doctor's visit if the patient is sick, but they will not pay for the "complete physical" associated with the initial visit. Some primary care physicians will not see new patients unless they can pay $ 350 - $ 500 insurance for a comprehensive visit. If you search the Internet for "head-to-toe" and "obsolete," you will find many websites that provide arguments and evidence that complete physical activity is not necessary but may be confusing for some patients. In contrast, blood tests are ten times more important than complete physical therapy for new patients.

We often hear the argument that good basic physical examination with laboratory work is important and can help patients in their own care as well as identify patients at risk for heart disease, diabetes, and other problems. Patients centered on a medical home model are built on coordination of care, not care. For standard health insurance policies (policies other than short term policies), at least one "physical test" or annual well-being is covered 100% by insurance and at no cost to consumers.

I'm looking for a new primary care doctor and will see one by the end of the month. These appointments are for new patients and will be coded for insurance as "wellness visits, physical exams" although there will be little or no physical testing. Instead, I plan to use the time to tell my doctor what blood test I want on this visit to set the baseline, and in the process of explaining why I want them, he will learn about my medical history. I doubt there will be time left for appointments despite the limited physical examination, but we'll see.

My cholesterol number isn't always very good, it's amazing. The same goes for my C-reactive protein (heart attack risk measure) and homocysteine ​​(stroke risk measure). I haven't had a complete physical exam in over 20 years and haven't let them down a bit. I found it shocking that any doctor would overshadow my stomach and then tell me I didn't have any tenderness there, as if I didn't know it. I'm all in favor of preventive health care, but I agree with the U.S. Preventive Health Task Force that complete physical examination does not prove to be cost effective in preventing disease. Blood tests, on the other hand, are important to monitor overall health and are critical to formulating strategies for preventing illness and medical conditions.

I have been asking for primary care documents for several years now if they have experienced abnormalities in physical examination in asymptomatic patients who have not been invited as part of standard examinations (PAP smear, colonoscopy, laboratory tests, etc.) with minimal positive response. (A doctor diagnosed with oral cancer). Standard checks can be made more effective and efficient by non-physicians as part of the public health campaign: think about the Polio vaccine campaign of the 1940s and 1950s.

After that, consulting with the patient / client for the purpose of health planning - identifying what's important to them and the impact of health issues on the important things and then coming up with a coherent plan for how to achieve those goals - may not be valuable, especially if doctors have no financial interest in the choices they make.

However, we found a lack of evidence to support the "annual physical test" that led to early detection of health problems. I invite interested readers to click on the links at the bottom of this article to find references to the National Institute of Health pubs' links to annual physical activity.

In examining the population of high school and high school athletes who are required to gain "physics participation" to play on the sports team, one study found 1268 students, 5% referred to experts, but only 0.2% were disqualified from playing sports. The authors conclude that the majority of those who are disqualified will be met with only detailed medical history. Another study of 763 student athletes found 3 positive references. Factoring in the costs of all health workers involved, each of these three findings came at a cost of $ 4563. In addition, 16 medical problems were identified during the 763 student physical course, BUT 15 of the 16 problems, and identifiable certainly, rather than just taking the patient's medical history.

How do you think most primary care physicians will respond if a new patient has a medical history but refuses more than a brief physical test to get the required blood test? Does the typical primary care physician simply say "the patient passed the complete exam" and pass it on, or is it worse for the patient to get a complete physical, because of the way doctors always treat new patients? One problem with healthcare is that patients are generally obsequious and fall into a lockstep pattern of getting a specific test or test even though they have little benefit to their overall health.

I often hear from foreign-trained and foreign-trained doctors that "here in the United States, doctors spend too much time caring for people after their illness and not enough time to prevent the disease." But what does it mean in practical terms? (1) The doctor needs to order more blood tests to determine the average glucose level (HbA1C test) so that all patients know their HbA1C number and whether they have diabetes. Other useful blood tests will include hormone panels for all patients of middle age or older, and then doctors should learn about the optimal level for these hormones, rather than ignoring the results that fall into the "normal" environment but can be sub - optimal. (2) The doctor must have staff who can answer the patient's health questions, for example, whether the patient should take magnesium, without placing a burden on the doctor to answer all of these questions. (3) Patients should be targeted for HbA1C, HDL, total cholesterol / HDL, cortisol, etc., to achieve through their own proactive and informed food selection.

I cannot think of any blood tests to be ordered solely to make the patient aware. As a general rule, no doctor will be able to estimate blood test results, e.g., no doctor can estimate HDL cholesterol or total cholesterol simply by talking to a patient and obtaining a medical history. When insurance companies emphasize preventive health, they often emphasize physician testing over laboratory tests. But again, no doctor's exam can reveal 3 months' average glucose, or iron deficiency, or high liver enzymes. It sounds like some insurance companies want to do preventive health care at a cheap price, and with that attitude, they should not be surprised that the limited range of preventive care they support is useless.

To say that the annual physical is worthless without telling the public that some health monitoring is needed may send the wrong message. After all, it's hard to argue that monitoring hypertension, lipidemia and diabetes is not worth it. The FDA has generally been shown by its refusal to approve OTC versions of maintenance drugs that people cannot trust to monitor or manage these diseases.

I'm all in favor of monitoring hypertension, lipidemia, and diabetes. In fact, where the Affordable Care Act recommends diabetes examining people with high blood pressure, I would go further to say everyone needs to know the HbA1C number (3-month hemoglobin average). But why aren't these values ​​checked out on regular preventative health visits, without the need for a head-to-toe physical? No article says that laboratory tests are worthless; they tend to question the "annual physical" value of healthy adults without symptoms. Indeed, some doctors have recognized this fact and have given patients a more limited and directed examination. That approach makes more sense than the "one size fits all" approach with head to toe testing.

The FDA generally indicates that people cannot be trusted to monitor or manage these diseases. I strongly disagree with the FDA and question its motives in preventing cholesterol and hypertensive drugs from being accessed by OTC. I hope in my life that they become available. Enlightened individuals can use the Internet to learn about drugs that lower blood pressure, glucose, and lipids, along with the side effects of drugs. Home blood pressure devices are more effective in monitoring real-world blood pressure than regular visits to a doctor's office. Accurately enlightened patients can isolate anti-hypertensive drug doses to bring their blood pressure to an optimum level (below 115/75 mm Hg in most people).

For an expanded version of this article, please see http://www.michaelguth.com



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