Patient & Doctor Value Visit

Visits to your doctor or any healthcare provider can be frustrating and time consuming for all involved.  These are some things you can do to make it an easier and more productive.

One of the first things you want to do is make a written or typed medical history to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago or even last year.

It is a good to make appointments when you are well and stable.  Keep a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.

Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." This gives you a complete assessment of all your medical problems. You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to poor handwriting. It is surprising to see how many doctors are often unable to read their own writing.

Schedule your appointment for first available times in the morning or afternoon.*  This will likely ensure that you will be seen on time with a shorter wait time and longer visit.  It will help you and your doctor focus on your total health care versus acute, intermittent health concerns that can easily take up your whole time. Unless an emergency arises, the wait should be less than 15 minutes.  If there is an emergency you should be notified and given the option of waiting or rescheduling, or going elsewhere for treatment. 

The easiest thing you can do is be on time.  Best health!

*How to Make Your Doctor Appointment http://bit.ly/akMrpX

by J.L, Richardson, M.D., family medicine expert and author of Patient Handbook to Medical Care: Your Personal Health Guide, honorable mention of Writer's Digest International Self-Published Book Award** and Indie Excellence Award finalist.

(**Written by a reliable source, this book is the perfect quick reference for all of those squeamish people who hate going to the doctor. I am one of those people. I hate wondering why a certain test was performed, exactly what a common diagnosis may mean, what the proper specialist for my malady might be called, and negotiating the maze of health insurance forms and other paperwork that seems to accompany my ailment; thereby adding insult to injury. To avoid the mystery, misery, and tedium of the wellness process, I often remain sick in order to forego or delay much needed medical appointments. The author writes for people like me; she writes in a calming, professional tone and explains, in as simple and non-threatening a manner as possible, what I can expect along every step of the healing process. By learning to keep a medical diary, knowing what to expect of my medical staff as well as how to decode their complicated language, and then by understanding the basics of the complex American healthcare system, I can take charge of my own healthcare. This little book provides me with all the tools necessary to do just that. ~Writer's Digest)

Men's Health Month Memorandum: It's Checkup Time!

"If I had known I was going to live this long, I would have taken better care of myself." — Mickey Mantle

Statistics show that men are less likely than women to get routine health checkups and physical exams. Men are more likely to seek medical attention when there is an acute problem, and once that has resolved not until another acute problem. Part of the reason for this is lack of health education. Men are also more prone to the "this can't be happening to me" syndrome. Is ignorance truly bliss? Short term, maybe. Long term, no.

So what is a fella to do? Make a yearly checkup routine. Do it around your birthday or holiday like Father's Day or Christmas as a gift to yourself (your most important asset!). In addition to a complete medical history (be sure to take your notes and questions http://bit.ly/122ZEeF) and physical exam, there are other things your doctor should do. This includes:

• complete blood panel including a PSA (prostate specific antigen) if over 40 or have a history of prostate cancer in your family - please note that PSA screening is very controversial as to if it should be done and should be discussed at length with your doctor as this test does save lives
• EKG, baseline at first physical then every 2-3 years - yearly if over 50, have risk factors such as smoking, obesity, hypertension, diabetes, increased cholesterol, family history of heart disease
• cardiac screening by a cardiologist if any signs or symptoms of heart disease especially if there is a family history of heart attack, angina
• colon cancer screening with stool guaiac cards - stool samples are placed on these and returned to your doctor who checks for blood (this should be done when a rectal exam is performed, but if for some reason it is not, be sure to get these cards)
• colonoscopy, baseline at 50, sooner if stool positive for occult blood or gross rectal bleeding, weight loss, stomach symptoms

Be sure to include regular visits to the dentist, and optometrist or ophthalmologist (eye doctor).

Best health, guys!

by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.

Listen to What Your History and Physical Should Include http://bit.ly/2MC0r5c

10th ANNIVERSARY PATIENT HANDBOOK TO MEDICAL CARE THANK YOU

This year marks the tenth anniversary since publication of Patient Handbook to Medical Care: Your Personal Health Guide.  Thank you all for reading my book and nine year old blog.  This book was written to help each and every one of you for we all are patients at some time in our lives.  The primary intent and purpose for writing Patient Handbook to Medical Care: Your Personal Health Guide was to help patients learn the basics involved in seeing your doctor and healthcare providers.  It was far too much to tell in a short office visit so I decided to write it down and self-publish!
Since 2006 publication, Patient Handbook to Medical Care: Your Personal Health Guide has become available in many libraries and bookstores (on and off line). There is a Kindle e-book with plans for the audible version.  The blog has been viewed by so many!  Book giveaways, sales, and blog reads are an indication of the patient interest in health facts and information. Health literacy improves your health care in all ways. It helps you make the right choices for you and your family.

Again much thanks to you all! Best health!

What Your Blood Tests Really Mean

When the doctor orders blood tests (also called lab tests, blood profile/ panel), she or he is checking for certain things. The most common tests are CBC (complete blood count), basic complete blood panel, and UA (urinalysis). The CBC checks the body’s WBCs (white blood cells) and RBCs (red blood cells). In the lab the cells are examined for size, shape, and number. The WBCs may tell if you may have some type of infection or leukemia(cancer of the white cells). The RBCs carry oxygen to the rest of the body. This is done by hemoglobin, which is carried inside the RBCs.  Some inherited diseases, such as sickle cell
anemia and thallassemia, can be identified by abnormal RBC shape and size. Also included in the CBC is a platelet count. Platelets are cells that help your blood to clot, for instance to stop the bleeding after a flesh wound.

The basic complete blood panel measures many different things. Included in these tests are:

• Na = sodium

• Cl = chloride

• K = potassium

• Mg = magnesium

• Glc = glucose (sugar)

• Ca = calcium (bone mineral)

• PO4 = phosphate (bone mineral)

• BUN = blood urea nitrogen (kidney)

• Cr = creatinine (kidney)

• SGOT = serum glutamic oxaloacetic transaminase (liver)

• SGPT = serum glutamic pyruvic transaminase (liver)

• GGT = gamma glutamyl transferase (liver)

• Alk phos = alkaline phosphatase (liver, bone primarily—also gallbadder)

• Fe = iron

• TIBC = total iron binding capacity

• transferrin = iron

• uric acid = checks gout

• chol = cholesterol (fat)

• LDL = low density lipoprotein (“bad” cholesterol)

• HDL = high density lipoprotein (“good” cholesterol)

• TG = triglycerides (fat)

Blood panels may differ from lab to lab. The above tests make up the basic chemistry panel. This should be part of a routine checkup. Some panels may include more tests than those listed above. The urinalysis (UA) may or may not be included, but it is important. Urine tests are able to check for infection, sugar, blood, protein, and many other things. Additional tests that may be ordered by the doctor for preventive screening will depend on your symptoms, diagnosis, family history, and age. Some of these tests are:

• PSA = prostate specific antigen (prostate cancer test)

• TSH = thyroid stimulating hormone (thyroid function)

• T4 = thyroid hormone (thyroid hormone level)

• B12 = vitamin B12

• folate = B vitamin

The Pap smear test and stool for occult blood (blood in stool that cannot be seen with the

naked eye) should also be performed. The Pap smear is a test for females that checks for cancer of the cervix. The stool test, also called Hemoccult test, checks for blood in the stool, which may indicate bleeding from the bowels secondary to cancer, ulcers, or other serious conditions.


Other tests than those listed may be checked depending on your history and physical exam. Be sure you are scheduled for a return visit to follow up on all tests. Some doctors’ offices will also let you know by phone or mail, especially if there is an abnormal test that must be checked before your next appointment.

Your symptoms, the doctor’s physical findings, and blood test results are what the doctor looks at when deciding the next tests that need to be done. This and any additional tests may be used for screening, diagnosis of conditions, and for ongoing management of disease once it is present.

Your Physical Exam: Below the Waist

After the physical exam above the waist is completed, the rest of the exam follows. For females, the pelvic exam and rectal exam are done next. The pelvic exam can also be done by a gynecologist, a doctor who specializes in female medicine. This depends on your preference and/or if your primary care doctor chooses to refer you. It is an examination of the female external(outer) genitalia (parts) and internal (inside)reproductive sexual parts. The first female exam should be done at any age if there are any symptoms. Routinely, the first pelvic exam is done once the female is sexually active (having sex) or 18 years of age. It is recommended that a third person or chaperone who is an authorized health professional should be in the room for this exam. Every health care setting should have chaperone policies in place for gynecology exams. This should always be presented as an option, if there is no policy or law. Furthermore, it should be offered to a patient for the full physical examination, especially if the physician is the opposite sex of the patient.

The assistant will help you get in position. Your legs will be placed in stirrups (foot holders) that are at the end of the table. You will then slide your hips down until the buttocks touch the edge of the table. Your legs will then be able to relax
apart. (Some doctors have more comfortable exam chairs.) For those who might not be able to do this, there is the frog-leg position. The heels are brought together while the legs are bent: the heels are, thus, brought as close as possible to the
buttocks, like frog legs. For persons not able to assume either of these positions, referral to a gynecologist is necessary. Please note also that you should not be put in this position until the doctor is ready to examine you. That’s just good manners on the doctor’s part. Once the exam begins, the doctor will instruct you when to lie down. You should also be informed when and where you will be touched during each part of the exam. The doctor will be wearing latex gloves to do this part of the exam. You may also request that a mirror be placed so that you can watch the exam.

There are five basic parts of the pelvic exam. The first part is the exam of the external genital area where the doctor inspects and palpates for any abnormalities. The second part of the exam is done using a tool called a speculum. This is for looking into the vagina and at the cervix. It resembles a fancy pair of tongs (or a pelican beak) and is either plastic or metal. Most doctors
will and should warm the speculum with water before use. This allows for easier passage of the speculum. In the closed position the speculum is then placed gently in the vagina and opened to keep the vagina walls apart. When this is done,the doctor is able to see the cervix. The third part of the exam involves doing a Pap smear, which is a screening test for cancer of the cervix. A thin wooden stick about the size of a popsicle stick(called a spatula) and a stick with a tiny (about quarter-inch) brush on the end are used to do the test. When gently rubbed against the cervix, they are able to pick up cells. The cell samples are then placed on a glass side or in a test tube, which is then sent to the lab. The speculum is then removed.
Part four is the bimanual exam, which includes palpation of the internal female organs. One or two fingers that have been lubricated are placed in the vagina, while the other hand presses
over the pelvic (lower abdomen) area. The uterus(womb) and ovaries (eggs)can be felt for any tenderness or masses. The last part of the exam is the rectovaginal exam. Using a clean lubricated glove, one finger is inserted into the vagina and a
second finger into the rectum. This is an important part of the exam for two reasons: to check the rectum for bleeding and masses, and to further palpate the female organs. A complete
pelvic exam includes a rectal exam. The stool is checked for blood by placing a sample of stool from the gloved finger in the rectum onto a special card (commonly called guaiac or Hemoccult cards). If there is no stool for the specimen, your doctor will give you cards with instructions on how to collect samples at home. Once completed, the cards are returned to the doctor to be checked for blood. This is a very important test. Small amounts of blood in the stool cannot be seen with the naked eye but can
be detected with this test.

The male genital exam is the equivalent of the female pelvic. The doctor inspects first. With gloved hands, the penis glans (tip) and shaft are checked. If the male is not circumcised, the
foreskin (extra skin) should be pulled back. Then each scrotal sac is palpated to check the testicles for any abnormal lumps or bumps. This is a good time for the doctor to show you how to do your own monthly scrotal exam. Next the famous “cough” test is done in standing position. This is to check for hernias and is done with the insertion of the examining finger into the scrotal
and inguinal (groin) area while the patient coughs. It is done on the right and left side. The rectal exam follows and is usually done with the doctor’s lubricated gloved index finger inserted into the rectum. In addition to checking the stool
for blood, the prostate gland (which makes male fluids) is also checked for size, tenderness, and masses. This is an important cancer screening test for men and should be done routinely after age 40.

Examination of the musculoskeletal system(arms, legs, back), nervous system (including mental health), and skin mark the end of the complete physical. The extremities (arms and legs)are checked for symmetry (the same on both sides, and were being checked as you got on and off the exam table, to see if you required assistance or were using an assistive device such as a wheelchair,walker, or cane. Following instructions and answering the doctor’s questions during the exam allows for an indirect check of the nervous system. The skin can be inspected as each of the previous parts of the physical is done. Be sure to
have the doctor show you how to do your own self skin exam.

The inspection of the extremities continues as the doctor looks for scars, skin color change,edema (swelling), and effusions (joint swelling). The joints of the arms and legs are then tested for range of motion (actual movement) actively (movements done by patient) and passively (extremities are moved by the doctor). They are also checked for any tenderness, swelling, and
warmth or coolness. The strength, reflexes, and sensation(feeling)in the extremities are usually tested at this time or can be included in the neurologic(nervous system) exam. Strength is tested by resisting the doctor’s strength. Pushing the hand against the doctor’s hand, kicking the leg out, and gripping a finger with your hand are all relative tests of strength. The reflexes are checked with a reflex hammer at several places on
the arm (front and back of the elbow, above the wrist) and leg (below front of knee, back of ankle on Achilles’ tendon). Sensation can be checked using different items but is usually checked by light touch on the same parts of the arm or leg at
the same time. A sterile pin touched lightly on the area to be checked can also be used. Different areas of the body are touched while the patient’s eyes are closed and the doctor asks whether the touch feels the same on both sides or if a sharp or
dull feeling is experienced with the pin. Position sense is checked by being able to tell if your finger or toe is being held up or down with eyes closed. Vibration sense is tested on a finger or toe joint with a tool called a tuning fork (a six-inch
or so steel piece that vibrates when tapped lightly). Your job is to tell the doctor if it’s vibrating and when it stops. Finally, the extremities are checked for the pulses(circulation) in the arm and leg and for any vein abnormalities.

The rest of the neurological exam involves checking the way you walk, talk, and answer a few questions designed to check the mental state(such as where you are, the date, ability to identify a simple object). The cranial nerves(nerves involving the face and neck area) can also be checked now, if they were not included in the head and neck exam. During the back exam the doctor first looks at your posture. The shoulders and hips are checked for symmetry and deformities. The muscles of the neck, posterior thorax (chest), and lower back are palpated to check for any tenderness or spasm. Likewise, the bones of the spinal column are also checked. Movement of the neck and lower back is
done actively and passively in all directions of movement.

Please be reminded that the way the physical exam is done may vary from doctor to doctor. This is unimportant as long as a complete physical exam is done. Please note that the above
description of the CPE is quite generalized and does not include every specific detail. Book references for more detail include: "Bates Pocket Guide to Physical Examination and History Taking" by Barbara Bates, M.D., et al. (also available on CDROM
and VHS tape), and "Bedside Diagnostic Examination" by Drs. Elmer and Richard DeGowan. Many medical school curricula use
these references.

Once the physical exam is complete, the doctor and assistant will leave the room so you can get dressed. If an EKG (electrocardiogram — heart tracing) and X-ray are going to be done, you may be asked to get partially dressed (bottoms only) and keep the gown on. If blood has not been taken, that can be done at this time, too. Following these tests you will be able to get fully dressed. The doctor will then sit down with you in the office or exam room and discuss your symptoms,the physical findings (normal vs. abnormal), diagnosis, and whether any further tests or treatments are needed.

This is also the time for obtaining any prescriptions and to be told about any further tests or specialists whose expertise will be required. The doctor may also counsel you with information about your diagnosis and treatment, as well as any number of preventive healthcare topics. You may also be given handouts and booklets. Doctors may refer you to pertinent medical and patient education websites such as www.webmd.com. Email is becoming another way to talk with your doctor, in addition to phone calls, regular mail, and faxes. Prescriptions for medication are usually given to the patient at the end of the visit. Prescriptions are written orders for medicine that the doctor
has chosen for you. The patient should take these to the drugstore as soon as possible to stay well or to hasten recovery. Prescription medication must be dispensed by a licensed pharmacist. Some doctors fax or call the prescription in to your drugstore. Asking the doctor to do this for you will ensure you receive your medication promptly and will save you a trip to the drugstore. Some doctors are now using e-prescriptions
over the computer to send in patient prescriptions. By giving your doctor the number for the druggist you use, you will be able
to get a prescription filled in less time. You may also get prescriptions for medicine that can be bought over the counter—that is, without a pharmacist. Your pharmacist is the best person to help you with obtaining your medicine, discussing side effects and interactions, what the medicine is for, and so on. Be sure to discuss this with your doctor, too.

Best health!



Patient Handbook to Medical Care: Your Personal Health Guide http://amzn.to/13m51UU FREE with Kindle unlimited!

Your Physical Exam: Above the Waist

After your doctor has taken a thorough medical history, a complete physical exam (CPE) is performed. The doctor started your physical exam from the time you were greeted just by looking at you. Are you able to get up and shake hands? Are you able to sit back down? Is there a cane or walker lying beside you? Are you speaking clearly? Are you tearful? This and many other observations can tell the doctor a lot. So the physical has begun before the doctor puts a healing hand on you.

The head, eyes, ears, nose, and throat (HEENT) are usually inspected first. The doctor looks at the scalp for any hair loss or other abnormalities. Your head is palpated (touched and felt) to check for any lumps, swelling, or sore spots. The eyes are next. You will be asked to follow the doctor’s finger with your eyes up, down, left, right. This tests your eye muscles. Pulling down the lower eyelid and pulling up on the upper eyelid allows for inspection of the white of the eye and the eyelids. The eye reflex is checked by shining a light on the colored part of the eye and is done with the lights dimmed (or light off and door cracked). The doctor uses the ophthalmoscope (an instrument) to look inside the eye. The blood vessels and nerve to the eye can be seen. Certain abnormal findings in the eye indicate diabetes, high blood pressure, and other maladies. For any findings that are abnormal with the eye, you will be sent (“referred” is the
up-to-date term) to an ophthalmologist (eye specialist). Routine eye exams by the ophthalmologist may also detect some diseases that are known to progress toward blindness or other complications. Looking at and reading from an eye chart tests the vision.

Can you hear a whisper? How about a watch ticking? Faint noises close to the ears allow a doctor to check to see how well you can hear. Formal hearing tests (like audiometry) are done by an otolaryngology doctor, also known as the ENT (short for ear, nose, and throat) doctor. Hearing tests may also be done by hearing aid centers. The doctor uses the otoscope (the same instrument used for the eyes with an attachment made for looking in the ears) to look in the ear canal and at the eardrum. Using the same tool, each nostril and the mouth are inspected. A stick called a tongue blade is used to hold the tongue down when the doctor asks you to say “aaaaahhhhh.” This is done so that the throat and the rest of the mouth can be checked. This procedure also tests the nerve for the gagging reflex (part of the nervous system exam). A gloved finger may be used to palpate (touch) the inside of the mouth. Any problems here will earn you a referral to the ENT doctor or dentist. Now may be a good time to ask any questions about the exam thus far. Please wait for the doctor to remove the gloved hand first.

The neck exam is next. At this time the thyroid gland is palpated. This is best done while the doctor stands behind the patient and places the right hand around the right side of the neck and the left hand on the left side of the neck. If any swelling or lumps are noted, further blood tests and a thyroid and/or neck scan may be ordered by the doctor. The lymph node glands can also be checked at this time. They are located in the front, back, and sides of the neck. They are also in the armpit and groin and are checked with those parts of the body. The lymph nodes should not normally be enlarged. More blood tests and Xrays may be ordered if they are enlarged.

Inspection, palpation, and percussion (lightly tapping) as well as listening to the chest give the doctor a chance to check the lungs. The doctor listens with a tool called a stethoscope, which makes the sounds louder. It is placed on the bare skin (beware of the doctor who tries to listen on top of your clothes) starting at the top of your upper back moving from the left to right, or right to left, from the top to the bottom of the chest
while you take deep breaths. The same will be done on the chest.

Then the stethoscope will be placed over the heart on the left and right sides of the breastbone. These areas are where the heart valve sounds are heard best. You may also be
asked to do certain things like holding your breath or bearing down (as when having a bowel movement). This makes some murmurs easier to hear. Certain positions may also be better for hearing some heart sounds. Your doctor has been trained to listen for certain things. If any abnormal sounds are heard, more tests may be ordered. These may include an X-ray of the chest(CXR, for short) and heart tracing(electrocardiogram—EKG, for short). Usually these can be done in the office after completion of the exam. Depending on your complaints, symptoms, and the results of the CXR and EKG, you could require more tests that are not done in the primary care physician office.

The breast exam is also done at this time. The doctor will let you know exactly what is to be done. For female patients, it is recommended that a third person or chaperone be present when this exam is done. After the gown is lowered to the waist, the doctor looks at the breasts with the patient sitting up on the exam table. The breasts should look the same size (sometimes one can normally be a tad larger or smaller than the other) and shape with the nipple positioned centrally. The breast is also checked to make sure there is no abnormal swelling, lumps, skin discoloration, or skin changes. Next you will be asked to put your hands on your hips and then raise your arms above your head much like doing your own breast inspection in front of the mirror. The doctor will again look and examine for any abnormal places. While you lie down on the exam table, the doctor will palpate each breast up and down vertically from right to left or vice versa. Palpation in a circle from out to in is another technique used. Breast tissue under the arm is also checked. The nipples are then squeezed gently to check for any discharge. Deeper palpation of the axilla (armpit) is then performed to check the lymph node glands. These steps are then repeated on the opposite breast. Any abnormalities may warrant a
mammogram and/or sonogram and possibly a surgeon’s evaluation. Men should also receive a breast exam. This is a good time for the doctor to teach to do your own self breast exam (SBE).

Now it’s time to look, listen, tap, and feel the abdomen, the area many people refer to as the stomach. This is where the liver, spleen, kidneys, bowels, and female reproductive organs are located. With this lineup of important organs the doctor has a lot to check. This part of the exam is done in the supine (lying on your back) position. Looking at the abdomen for scars tells about anysurgery you may have had. Listening with the stethoscope for overactive or underactive bowel sounds and/or bruits (sounds made by abnormal blood flow through arteries when there is blockage) is next. By tapping and feeling, a doctor is able to check for enlargement of the vital organs listed and to make sure that there are no abnormal internal masses or swelling. At this time the groin is also checked for any enlarged lymph nodes. If there are any abnormalities, further tests will be ordered by the doctor.



Patient Handbook to Medical Care: Your Personal Health Guide
http://amzn.to/13m51UU FREE with kindle unlimited!

Body Scan for Early Detection

No prescription is needed for a body scan.. This is one of the most efficient health assessment tools that appears to be under utilized by the medical profession (fear of finding stuff they are unable to answer?). It is rather affordable, however, results yielded may pave the way for more expensive tests.

Reasons you should have a body scan:
_early detection of disease
_baseline exam for future reference & comparison
_follow chronic disease & abnormal findings like incidentalomas
more on these incidental findings here: http://bit.ly/9ANS09

Physical exams fail to pick up disease at the earliest possible stage. Total body scanning in conjunction with a physical exam and blood tests increase the likelihood that health issues will be detected earlier.

Best health!

by J.L. Richardson, M.D., family medicine physician and author of Patient Handbook to Medical Care: Your Personal Health Guide"

http://www.mypatienthandbook.com/
www.twitter.com/MD4U

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).

Your Health & Medical History

One of the first things your doctors and healthcare providers want to know is why you made your appointment. Once you answer this question (hopefully before interruption) there will be questions about your general health and wellness, as well as more information about your reason for the visit. For specific concerns you may be asked:

• How long has this been going on?
• What have you done for it?
• Have you had it before?
• Where does it bother you?
• How often does it occur?
• What makes it better or worse?
• Are there any other symptoms?

You will be asked about how the other parts of the body are working, such as your eyes, ears, heart, breathing, and so on. This is called the “review of systems” (ROS). If there are any problems not related to your main problem, now is the time to let the doctor know.
This will be followed by your past medical history (PMH), which includes:

1. Diseases you have (high blood pressure, sugar diabetes, arthritis, cancer, depression,
   etc.), or have had that are better or gone (including childhood diseases such as
   measles, mumps, and inherited disease)
2. Operations and times you were in the hospital (including accidents)
3. Medication, including prescription, over-the counter (don’t forget about vitamins),
   natural (garlic, aloe), and herbal
4. Allergies and reactions to anything and what it did to you (for example: breaking out in a
   rash, swelling, itching, upset stomach, etc.)
5. Smoking, alcohol, drug use (how much,
   how often)
6. Shots (childhood, flu, last tetanus, etc.)
7. Sexual (active, using protection, number of partners, diseases)—in females this will also
   include menstrual period, pregnancy, last mammogram, and Pap test
8. Family history (conditions that run in family
   such as cancer, high blood pressure, etc.)
9. Social history—your job or jobs; family; marital status; living arrangement (house,
   apartment, alone, etc.); transportation (drive self, public transport, walk); ambulation
   (use walker, wheelchair); disability (deaf, blind, amputee, etc.) Religion, ethnic customs, and traditions

If there is anything left out or that you feel the doctor should know, now is the time to speak up. It is sometimes hard to get someone’s full attention, so take advantage of it while you have it. Some doctors’ offices will have you fill out forms asking the above questions or will ask you the questions and fill out the form for you. This is not a substitute for the doctor’s personalinterview and questions.

Writing or typing this information is a sure way to keep all of your PMH. Make a copy for your doctor. While talking you both can refer to this vital source of health information. This is part of your medical record.

Best health!

Use this handy form to get you started http://bit.ly/bEvHk6

Women's Health Checkup

Ladies, schedule your routine screenings and appointments to include:

1. mammogram/ MRI for breast cancer
2. PAP smear & HPV test for cervical cancer
3. stool check for blood (fecal occult blood test, FOBT) for colorectal cancer
4. cardiology doctor for cardiovascular prevention(get EKG, ECHO, and thallium stress test if indicated)
5. bone density scan to check for osteoporsis
6. counseling for smoking cessation, alcohol/drug dependence, and domestic violence
7. evaluation for depression and other mental disorders if necessary
8. complete physical exam, and routine blood tests.

Get in 5 to 10 minutes of exercise a day at least and eat healthy! Laugh a lot and love a lot!

by J. L. Richardson, MD, family practice doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.

Doctor Visit Tips

Going to the doctor can be quite a challenge. These tips will help you make the most of your doctor visit.

One of the first things you want to do is make a written or typed medical history* to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago.

Start keeping a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.

Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to legibility. It is surprising to see how many doctors are often unable to read their own handwriting.

Stay on top of your health care with these tips. After all, great health is true wealth!

Click on "Comments" below to add your tips and questions.

by J. L. Richardson, MD, family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide, the perfect tool for helping you make your medical visits the best.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd



More tools to help you with your doctor visits:

http://www.mypatienthandbook.com/ - *medical history form on website.

Medical record release form - http://office.microsoft.com/en-us/templates/TC010234611033.aspx?CategoryID=CT101433201033

Medical tests A to Z - http://www.medicinenet.com/procedures_and_tests/article.htm

Specialists A to Z - http://www.healthadvantage.org/body.cfm?id=85

Your Personal #Health Guide on Google Books

Read excerpts at Google Books http://books.google.com/books?id=kPmXiNrg1pYC&printsec=frontcover&dq=patient+handbook+to+medical+care

Patient Handbook to Medical Care: Your Personal Health Guide is written for patients by a medical doctor "to inform and educate patients about medical care". Health maintenance, prevention, early detection, and early treatment are the foundation for great health.

This Writer's Digest International Self-Published Book Award winner informs patients about
basic medical care. By reading this how-to reference book you will learn:

• how to keep a medical diary
  
• how to get your medical records
  
• how to document your complete medical history
  
• what the physical exam should include
  
• about preventive tests and when to get them
  
• about tests your doctor orders
  
• about specialists and other medical providers
  
• about health care plans and coverage
  
• how to seek quality health services.

Also featured are "My Health Notes", blank pages for you to write your medical history, questions, and things to discuss with your health care team!

Great health is true wealth!

Preventive Medical Screening

Doctors and organizations may rant and rave about some preventive medical tests as "out of date". Think about the people you know who found a breast lump or had a high blood PSA test and later found out it was cancer. Today, in one day, I talked to three friends who told me how preventive tests saved their lives. They are all long term survivors.

Early detection and treatment as well as prevention can save your life. The tests are out there. You must know about them and decide for your self. Every life counts.


J.L. Richardson, MD, family medicine doctor, and patient advocate is the author of the award winning Patient Handbook to Medical Care: Your Personal Health Guide.

Self Check You

We the people of this mighty fine country vow to take the absolute best care of our most important asset - US. A nation is as great as its assets. We have so many. As long as us Americans stay healthy, we will stay wealthy.

True wealth is great health. It is time for you to take responsibility for your health. It is time for you to know what your health numbers are. It is time for you to know your medical conditions, risk factors, and family medical history.

Give yourself a medical checkup. Start by writing or typing or recording your medical history - medical conditions, surgery, treatments, family history. Add your medication. Save it. Update it. Add to it. Correct it. Keep it current. Keep a copy in a secure place.

Examine as much of yourself as you can. Look at your skin, hair, nails, eyes, teeth, and every part of your body that is visible to you. Make note of any abnormalities. Make note of any symptoms you have - new, old and ongoing. Go through each body system. Add this information to your medical history. Add to this your doctors' and health care providers' names, phone number, land address, and email address.

Call your doctor for an appointment for a comprehensive CPE (complete physical exam). Take your information and notes with you on your appointment. Review everything with your doctor. Take notes.

Sign a medical record release to obtain a copy of your medical record from each doctor you see at the time of the visit.

Be sure to schedule a follow-up appointment within a month or less to go over everything with your doctor. Get copies of your information including blood tests, and any other tests as well as medical notes.

Take charge. Be the healthiest you can be - as a person, as a nation.

Great health is true wealth!

J. L. Richardson, M.D., family physician patient advocate, is author of Patient Handbook to Medical Care: Your Personal Health Guide.

Fiscal Physical Health of America

America's fiscal physical health is failing. You are part of that body. Have you done your part to make America healthy?

President Obama addressed this issue today. It is great to finally hear more things like "lower your premium" quality healthcare coverage. Health insurance premiums should be capped. What if everyone paid the same amount regardless of present, pre-existing, or future conditions?

Genome genetics will help us live longer and better, but it will also help insurers predict your pre-existing conditions. Your family history is an accurate predictor, but much less so.

Maintaining good health and prevention of disease are the top priorities in keeping America healthy. Early detection of disease makes America stronger. America's health team has the tools you need for medical maintenance. The best in the world, it is often said. It is up to you to build good health.

America's fiscal physical health is a team effort. Do all you can do to lower your chances of becoming a chronic disease liability.

Save you and your money. Put prevention first.


J.L. Richardson, M.D. is the author of the award winning book,
Patient Handbook to Medical Care: Your Personal Health Guide.
http://mypatienthandbook.com/

Medicare Physical

Medicare Part B coverage includes an initial preventive physical exam (IPPE) to all new enrollees. This "Welcome to Medicare" physical exam is good for the entire year. In 2009 you have 12 months to get your physical. You are paying for it. You deserve it.

Call your doctor for an appointment before the schedule gets more filled up. Many doctors already have their schedules filled up to March especially specialists. There are less primary care physicians, and fewer are taking Medicare. It is an extremely prudent thing to do.

For more details go to www.medicare.gov
and/or call 1-800-633-4227.
(1-800-MEDICARE).

Self Check You - Be the Healthiest You Can Be

Congratulations, President Obama. You are healthy for this nation.

We the people of this mighty fine country vow to take the absolute best care of our most important asset - US. A nation is as great as its assets. We have so many. As long as us Americans stay healthy, we will stay wealthy.

True wealth is great health. It is time for you to take responsibility for your health. It is time for you to know what your health numbers are. It is time for you to know your medical conditions, risk factors, and family medical history.

Give yourself a medical checkup. Start by writing or typing or recording your medical history - medical conditions, surgery, treatments, family history. Add your medication. Save it. Update it. Add to it. Correct it. Keep it current. Keep a copy in a secure place.

Examine as much of yourself as you can. Look at your skin, hair, nails, eyes, teeth, and every part of your body that is visible to you. Make note of any abnormalities. Make note of any symptoms you have - new, old and ongoing. Go through each body system. Add this information to your medical history.

Add to this your doctors' and health care providers' names, phone number, land address, and email address.

Call your doctor for an appointment for a comprehensive CPE (complete physical exam). Take your information and notes with you on your appointment. Review everything with your doctor. Take notes.

Sign a medical record release to obtain a copy of your medical record from each doctor you see at the time of the visit.

Be sure to schedule a follow-up appointment within a month or less to go over everything with your doctor. Get copies of your information including blood tests, and any other tests as well as medical notes.

Take charge. Be the healthiest you can be - as a person, as a nation.

Great health is true wealth!


J. L. Richardson, M.D., family physician patient advocate, is author of Patient Handbook to Medical Care: Your Personal Health Guide.

www.mypatienthandbook.com

The website offers a FREE excerpt from the book about the information for your medical history. Check it out.