The Periodic Health Examination

health 131
health 131

Many seniors recall the times when we all had a family doctor and had a yearly health assessment and physical examination. More than a decade ago, a number of studies showed little benefit from these routine complete physical examinations on healthy adults, and both medical bodies and provincial government insurers modified their recommendations for a more focused periodic health examination for those with certain medical conditions or strong family histories of certain diseases.

A complete annual physical examination is not done routinely now for healthy individuals. For patients, especially seniors, who have pre-existing conditions, those on prescribed medications and patients who have a higher risk of developing medical conditions, it is still recommended that a focused periodic health examination be done. For seniors, the majority of us have one or more medical conditions and should be booking such an overall review of our health, usually on about a yearly basis.

According to one’s age and medical status, the health assessment and physical examination will be focused particularly on conditions which one has, or is at risk of getting due to family history, toxic exposure or age. Screening tests might be indicated and arranged, such as a mammogram for women older than 40 years of age, a prostate test (PSA) for men older than 50 or blood tests such as a hemoglobin, complete blood count (CBC), electrolytes, blood sugar, cholesterol level and kidney test (Creatinine). If there is a family history or symptoms suggesting a risk of bowel cancer, a test for blood or a colonoscopy may be indicated.

Patients with known chronic conditions such as hypertension, diabetes, heart conditions, anemia, respiratory conditions and others will be particularly reviewed with examination, review of progress and possibly further followup, consultation or investigation indicated.

During that examination, a review of one’s immunization status should be completed and, especially for travellers, arrangements should be made for necessary shots such as Covid, influenza, shingles, tetanus and others based on travel sites.

Unfortunately, with the shortage of family physicians in Canada, not only are there millions who do not have a regular family doctor to perform these examinations, there are also those who have a doctor, but are often never offered such appointments. Most family physicians have practices that have a full roster of patients and face much more pressure in treating acute medical problems and managing chronic conditions.

The patient needs to pay increased attention to his or her own health, as well as that of family members. Last week, I was fixing my lawn mower with my neighbour, a retired mechanic, when I noticed a large mole on his temple. It was very dark and had irregular edges and I immediately wondered if it was a malignant melanoma. I asked him about it and he said that it had been there for many months and it seemed a bit bigger. When asked whether he had seen his doctor about it, he replied that his family doctor had retired last year and he was unable to find another. I instructed him to attend a walk-in clinic as soon as possible and, if none were available, he should go to the local urgent health-care location.

There are other examples of persons who have not had routine followup for serious conditions. For example, a retired friend who curls with me told me of his wife who had breast cancer six years ago and was told to have regular followup mammograms. She was never given such periodic reviews of her health and had had no mammogram ordered in more than five years. I advised him to be sure that she booked a specific appointment to review this issue.

There are many conditions that can be detected with such periodic health examinations. Auscultation can pick up unknown conditions such as carotid narrowing, atrial fibrillation, other cardiac conditions and abdominal aortic aneurysm. Palpation can detect breast and abdominal masses, as well as circulatory problems that were not known. Visual examination can detect potentially malignant skin lesions and other skin conditions. Blood pressure measurements may show hypertension. At a Snowbird Winter Information Meeting in Clearwater a couple of years ago, my wife took the blood pressure of a 65-year-old friend of ours from Canada and the recording was about 200/120. He said that he was always healthy and had not had his blood pressure taken in years. He was advised to seek immediate attention for this dangerous level of blood pressure. His blood pressure is now controlled.

There are many conditions that can be diagnosed during such periodic health examinations. Diabetes is often detected in an asymptomatic patient. Cataracts, hypertension, atrial fibrillation and skin cancer are examples.

Kidney disease is a slowly developing condition in which the kidneys begin failing and may eventually result in total failure. Many are diagnosed when remedial measures are no longer effective and signs and symptoms of the condition require regular dialysis or kidney transplant. A simple urine test that shows protein in the urine allows for early diagnosis and appropriate dietary modifications for managing the condition.

In summary, the restriction of access to necessary medical attention affects not only those with no family physician, but may reduce appropriate care, followup and attention to recommended preventive measures to those who do have one. In this day of computer access to vital health information, if you suspect that you or a family member should be seen by a physician, you must actively seek such attention. Whether it be a new symptom, a chronic condition needing assessment, an immunization need or a long overdue personal health examination, don’t neglect to make the arrangements, even if your last resort is a walk-in clinic, or urgent care centre.

By Robert MacMillan MD