House Calls / Dr. Michael Schwartz
The annual physical examination -- "check-up" -- is one of the most important components to preventative health care. Each year, millions of Americans undergo comprehensive exams with the goal of identifying potential medical issues before they become serious. Many patients lack an understanding of what a complete physical examination entails as well as the significance of the various tests and the value of the assessments that may be reached by their physician as a result of the exam.
One of the most important aspects of a physical examination is the "history of present illness." This refers to any complaints or concerns the patient has regarding his or her health. The physician will discuss various lifestyle issues with the patient including alcohol consumption, caloric intake, exercise regimen, vaccination status, sexual and psychological health.
After a review of lifestyle issues, the physical exam will begin with measurement of height, weight and vital signs, i.e., blood pressure, heart rate and body temperature. Following these initial measurements, a more focused approach will evaluate individual body systems:
Vision Testing -- patients are asked to read an eye chart from a distance of 20 feet to ascertain visual acuity. Additionally, color blindness may be detected during this exam;
Audiometry (hearing test) -- an audioscope is used to generate sounds at various volumes and frequencies to detect subtle hearing loss;
Electrocardiogram (EKG) -- this heart test is performed by placing painless adhesive stickers on the body to measure the electrical output of the heart. This test may detect irregular heartbeats, determine the size of the heart and can even detect previous heart attacks;
Spiromety -- this test measures lung volumes. The patient is asked to blow into a machine which determines how much air can be forced out of the lungs. Results may reveal asthma, emphysema or airway restrictions;
Urine analysis -- this test measures substances in the urine. Finding blood, protein or sugar may indicate an underlying disorder.
After completing these initial tests, the actual physical examination consists of the physician inspecting (visualizing), palpating (feeling), percussing (tapping) and auscultating (listening to) various parts of the body to identify any abnormal findings. This includes:
General -- this refers to a patient's overall appearance including skin texture, build and mobility;
Head, eyes, ears, neck and throat -- the doctor may look for ear wax, inflamed sinuses, nasal congestion, lymph node enlargement and carotid artery disease.
Lungs -- listening for breath sounds to detect wheezing or fluid sounds which could indicate asthma, emphysema or heart failure;
Heart -- listening for irregular heartbeats or heart murmurs which may indicate underlying heart disease;
Abdomen -- feeling for liver or spleen enlargement and detecting masses which could indicate tumors or benign growths;
Groin/Pelvis -- feeling and observing for penile or testicular lesions in men and pap and pelvic exams in woman. Additionally, hernias (weakness in the abdominal wall) can also be detected;
Back -- examining for abnormal curves (scoliosis) or pain over the kidneys or spine can indicate stones or arthritis;
Skin -- the existence of a rash, nail changes or skin texture may indicate more serious underlying diseases;
Lymph nodes -- enlarged nodes may suggest infection or malignancy;
Extremities -- edema (fluid) or varicose veins can indicate circulation problems;
Muscles and Joints -- an assessment of strength and motion; joint swelling may indicate arthritis;
Rectal/Prostate -- prostate enlargement and cancers may be detected during this exam. Additionally, microscopic bleeding in the stool may suggest colon polyps or hemorrhoids;
Neurologic -- memory, nerve function and reflexes are examined to determine neurologic disorders.
At the completion of the exam, the physician will draw blood. Blood work is important in determining overall health and may be used to evaluate future risk of disease. There are many tests available and what is drawn is often based on the findings during the exam. In general, blood sugar, electrolytes, liver and kidney health along with complete blood count (red and white blood cells) will be measured. Thyroid hormones, cholesterol (lipid profile) and vitamin D are typically part of the routine screen as well. For men, depending on age, a prostate test and testosterone level may be drawn and for women, hormonal levels such as estrogen may be drawn to evaluate fertility or peri-menopause. Your physician's office will follow-up with you upon receipt of the blood results (typically within a week).
The physical exam is an exceptional means to promote health and well-being. Most importantly, it gives the physician the opportunity to address the patient's concerns and questions while counseling them based on their individual needs. Frequency of a physical examination is generally based on age and overall health. Although a physical will not always reveal all medical problems, they play an integral role in identifying certain conditions and are the first step to keeping us healthier.
So, let's get physical -- schedule your physical exam today and stay healthy.