Prevention Checkups: Is It Time for You?

Staying healthy and disease-free is what prevention is about. The complete physical is the beginning of prevention. The breast exam checks for cancer, as do the Pap smear and rectal examination. Depending on your age and sex, there are guidelines for when to have certain tests. These guidelines are recommended by health organizations such as the U.S. Preventive Services Task Force, American College of Physicians, American Cancer Society, and American Heart Association. These guidelines are by no means laws, but they serve as useful suggestions for you and your doctor to use in your prevention and treatment program.

So how often should you have a complete physical? When is it time for your next tetanus shot? I have reviewed guidelines from the various health organizations mentioned above and compiled a summary of adult preventive care standards. These are also based on my own clinical experiences and on the number of lives saved by doing tests, regardless of whether the time frame of the guidelines was observed.

ADULT PREVENTIVE STANDARDS
AGE:------------18–25----26–40 ----41–60----60+
Physical Exam 1–3 years 1–3 years 1–2 years yearly
Height/Weight 1–3 years 1–3 years 1–2 years biannual
Blood Pressure 1–3 years 1–3 years every year biannual
Eyes and Ears 1–3 years 1–3 years 1–2 years every year
Mouth 1–3 years 1–3 years 1–2 years every year
Breast Exam every year every year every year every year
Pap Smear* 1–2 years every year every year 1–3 years
Prostate Exam if needed if needed every year every year
Scrotal Exam every year every year every year every year
Rectal Exam if needed if needed every year every year
Stool Blood if needed if needed every year every year

COMPLETE BLOOD PANEL
AGE:---------18–25----26–40 ----41–60----60+
Lipid Panel 5 years 5 years every year every year
Liver Panel 5 years 5 years every year every year
Hepatitis 5 years 5 years every year every year
Kidney 5 years 5 years every year every year
Blood Count 5 years 5 years every year every year
Thyroid 5 years 5 years every year every year
Urine 5 years 5 years every year every year
Electrolytes 5 years 5 years every year every year
Glucose 5 years 5 years every year every year
Prostate (PSA) if needed if needed every year every year
HIV — test if any risk factors or exposure —

IMMUNIZATIONS**
AGE:----------------18–25----26–40 ----41–60----60+
Tetanusdiphtheria 10 years 10 years 10 years 10 years
Pneumococcal — as needed for persons at risk — once after 65
Influenza (flu) — as needed for persons at risk — every year
Hepatitis — — — — as needed for persons at risk — — — —
Measles-Mumps-Rubella — — if no antibodies, get 2nd dose — —

TESTS / PROCEDURES
AGE:---------18–25----26–40 ----41–60--------60+
Mammogram if needed 2–3 years every year every year
Chest X-ray baseline if needed if needed if needed
Electrocardiogram — — baseline — — every year every year
Colonoscopy if needed if needed 3–5 years 1–3 years
Body Scan baseline 1–3 years 1–3 years 1–3 years
DENTAL — — — — — — every year — — — — — —
MENTAL — — — — — — as needed — — — — — —

For any abnormalities, repeat screening and follow-up should be done sooner or more frequently depending on the individual person. For example, if your cholesterol is found to be increased when you are 18 years old or younger, you would want to have that checked at least every year instead of every five years. For people with a family history of breast cancer, yearly mammograms may start as early as the twenties.

Persons with a history of chronic illness (diabetes, hypertension, cancer, etc.) should have a yearly physical regardless of age. Frequent routine visits during the year are also in order for those with any chronic illness. In addition to preventive health screening tests, preventive health counseling is also very important. In addition to the doctor’s verbal counseling, ask for patient education references. Reading and knowing as much as you can about staying healthy also helps improve your quality of life and can make you feel better!

*Some sources recommend that after two normal PAP smears, repeat every 1–3 years.

**For further details, refer to the “Recommended Adult Immunization Schedule” published by The Advisory Committee on Immunization Practices (ACIP) from the Centers for Disease Control and Prevention (CDC).

Missed Diagnosis - Oooops!

Doctors are missing diagnoses especially with cancer - OVER 50%!!

Are you getting the right treatment? A 2006 study* of 307 closed malpractice claims revealed that many missed or delayed diagnoses in outpatients lead to serious harm, some fatal. In this study, 30% resulted in death! Adverse outcomes occurred in 59%.

The most missed diagnoses were cancer (breast and colorectal primarily), infections, fracture, and heart attacks. Fifty-nine percent of errors were associated with cancer diagnosis - or should I say misdiagnosis? Most of these malpractice claims (59% again) showed that diagnostic errors were significant.

The most common reason for failure to diagnose was failure to order the right test (55%). The other reasons were:
-failure to follow up (45%)
-failure to obtain a complete thorough medical history and physical
exam (42%)
-wrong interpretation of medical tests (37%)
Some cases were cited where the doctor failed to check the test results, or to tell the patient the results.

This data is truly mind blowing! Though a small study, it carries a lot of weight. The percentages are phenomenally high! How can this be happening in the most medically advanced country in the world? The fact is, it's happening. It is more common than we think - hidden, not talked about. What can you do to keep it from happening to you?

Has your doctor discussed preventive tests for cancer detection? Of course, you should have a routine complete medical history and physical exam first. Using this information your doctor will know what tests you may need. If cancer runs in your family, you really want to consider preventive cancer screening.

The medical history and physical exam give your medical facts. Findings on physical exam may suggest cancer for which testing is needed. Some tests considered for routine cancer screening are:
-mammogram, MRI - breast cancer
-PSA (prostate specific antigen) - prostate
cancer
-colonoscopy - colon cancer
-stool blood check - colon cancer
-PAP smear - cervical cancer
-complete blood count - blood cancer
-CT or MRI scan - lung cancer, brain cancer
-pelvic sonogram - ovarian cancer
-body scan (neck to buttocks and in between) - body (this scan shows other things ,
too).

Screening tests save lives. Talk to your doctor. Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up with your doctor to prevent any delays.

Get a copy of your test results. That way you will know if you were told everything and that the information is accurate. Research your results and diagnosis. Things you don't understand, ask again. Getting a second (and sometimes tiebreaker third because you were told different things by each doctor!) opinion is a reasonable research tool, also.

Patients must be their own advocate and take charge of their health. Health maintenance and prevention are so important to one's quality of life. Make it an important part of yours. Remember to do your own monthly breast exams for both sexes, and monthly scrotal check for the males.

Great health is true wealth!

(*from AHRQ, Agency for Healthcare Research and Quality, publication "Research Activities" February 2007 from study in Annals of Internal Medicine, 10/3/06)

J.L. Richardson, M.D., is a family medicine doctor, patient advocate, and author of "Patient Handbook to Medical Care: Your Personal Health Guide".