General medical examination


General medical examination

In medicine, the (annual) general medical examination is a common form of preventive medicine involving visits to a general practitioner by asymptomatic adults on a regular basis. This is generally yearly or less frequently. It is known under several other names, such as the periodic health evaluation, annual physical, comprehensive medical exam, or preventive health examination.

The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer, or regular visits for people with certain chronic medical disorders (for example, diabetes).[1] The general medical examination generally involves a medical history, a (brief or complete) physical examination and sometimes laboratory tests. Some more advanced tests include Ultrasound and mammography.

Contents

Usefulness

Although annual medical examinations are a routine practice in several countries, it is only partly supported by scientific evidence, and some notable health organisations recommend against annual examinations.[2][3][4] The American Cancer Society recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20.[5] It is commonly performed in the United States and the United Kingdom, whereas the practice varies among mainland European countries.

A systematic review of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol screening, and faecal occult blood tests) and less patient worry.[1] Evidence supports several of these individual screening interventions.[6][7][8] The effects of annual check-ups on overall costs, patient disability and mortality, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive.[1] A recent study found that the examination is associated with increased participation in cancer screening.[9]

The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge.[10] Despite guidelines recommending against routine annual examinations, many family physicians perform them.[11] A fee-for-service healthcare system has been suggested to promote this practice.[12] An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient.[3][13][14] This means choosing between a wide variety of tests.[15]

The arguments for and against are similar for many other screening interventions. The possible advantages include detection and subsequent prevention or early treatment for conditions such as high blood pressure, alcohol abuse, smoking, unhealthy diet, obesity and various cancers. Moreover, they could improve the patient-physician relationship and decrease patient anxiety. New York doctor finds that more and more private insurance companies and even Medicare include annual physical in their coverage. Some employers require a mandatory health checkup before hiring a candidate. Most surgeons will ask a patient for his or her recent general medical examination results in order to proceed with the surgery. [16] Disadvantages cited include the time and money that could be saved by a more targeted screening (health economics argument),[17] a possible increased anxiety over health risks (medicalisation), overdiagnosis and harm resulting from unnecessary testing to detect or confirm medical problems.

History

The roots of the periodic medical examination are not entirely clear. They seem to have been advocated since the 1920s.[18] Some authors point to pleads from the 19th and early 20th century for the early detection of diseases like tuberculosis, and periodic school health examinations.[19] The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine.[12][19][20][21][22] Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.[1][23][24]

References

  1. ^ a b c d Boulware LE, Marinopoulos S, Phillips KA, et al. (February 2007). "Systematic review: the value of the periodic health evaluation". Ann. Intern. Med. 146 (4): 289–300. PMID 17310053. 
  2. ^ US Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the Preventive Services Task Force 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
  3. ^ a b "Periodic health examination: a guide for designing individualized preventive health care in the asymptomatic patients. Medical Practice Committee, American College of Physicians". Ann. Intern. Med. 95 (6): 729–32. December 1981. PMID 7305155. 
  4. ^ Hayward RS, Steinberg EP, Ford DE, Roizen MF, Roach KW (May 1991). "Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force". Ann. Intern. Med. 114 (9): 758–83. PMID 2012359. 
  5. ^ Mettlin C, Dodd GD (1991). "The American Cancer Society Guidelines for the cancer-related checkup: an update". CA Cancer J Clin 41 (5): 279–82. doi:10.3322/canjclin.41.5.279. PMID 1878784. http://caonline.amcancersoc.org/cgi/pmidlookup?view=long&pmid=1878784. 
  6. ^ Screening for Lipid Disorders in Adults, Topic Page. June 2008. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspschol.htm
  7. ^ Screening for Colorectal Cancer, Topic Page. July 2002. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm
  8. ^ Screening for Cervical Cancer, Topic Page. January 2003. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm
  9. ^ Fenton JJ, Cai Y, Weiss NS, et al. (March 2007). "Delivery of cancer screening: how important is the preventive health examination?". Arch. Intern. Med. 167 (6): 580–5. doi:10.1001/archinte.167.6.580. PMID 17389289. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=17389289. 
  10. ^ Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ (May 2002). "Public expectations and attitudes for annual physical examinations and testing". Ann. Intern. Med. 136 (9): 652–9. PMID 11992300. http://www.annals.org/cgi/pmidlookup?view=long&pmid=11992300. 
  11. ^ Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ (June 2005). "Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers". Arch. Intern. Med. 165 (12): 1347–52. doi:10.1001/archinte.165.12.1347. PMID 15983282. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=15983282. 
  12. ^ a b Gordon PR, Senf J (May 1999). "Is the annual complete physical examination necessary?". Arch. Intern. Med. 159 (9): 909–10. doi:10.1001/archinte.159.9.909. PMID 10326933. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10326933. 
  13. ^ Lawrence RS, Mickalide AD (April 1987). "Preventive services in clinical practice: designing the periodic health examination". JAMA 257 (16): 2205–7. doi:10.1001/jama.257.16.2205. PMID 3560403. 
  14. ^ Frame PS, Carlson SJ (February 1975). "A critical review of periodic health screening using specific screening criteria. Part 1: Selected diseases of respiratory, cardiovascular, and central nervous systems". J Fam Pract 2 (1): 29–36. PMID 1123583. 
  15. ^ Beck LH (November 1999). "Periodic health examination and screening tests in adults". Hosp Pract (Minneap) 34 (12): 117–8, 121–2, 124–6. doi:10.3810/hp.1999.11.175. PMID 10616549. 
  16. ^ Benefits of a Timely Annual Checkup, Topic Page. June 2010. Dr. Marina Gafanovich, MD, New York, NY. New York Doctor
  17. ^ Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL (April 2003). "Primary care: is there enough time for prevention?". Am J Public Health 93 (4): 635–41. doi:10.2105/AJPH.93.4.635. PMC 1447803. PMID 12660210. http://www.ajph.org/cgi/pmidlookup?view=long&pmid=12660210. 
  18. ^ Emerson H (1923). "Periodic medical examinations of apparently healthy persons". JAMA 80: 1376–1381. 
  19. ^ a b Han PK (November 1997). "Historical changes in the objectives of the periodic health examination". Ann. Intern. Med. 127 (10): 910–7. PMID 9382370. http://www.annals.org/cgi/pmidlookup?view=long&pmid=9382370. 
  20. ^ Charap MH (December 1981). "The periodic health examination: genesis of a myth". Ann. Intern. Med. 95 (6): 733–5. PMID 7030166. 
  21. ^ Davis AB (1981). "Life insurance and the physical examination: a chapter in the rise of American medical technology". Bull Hist Med 55 (3): 392–406. PMID 7037084. 
  22. ^ Jureidini R, White K (2000). "Life insurance, the medical examination and cultural values". J Hist Sociol 13 (2): 190–214. doi:10.1111/1467-6443.00113. PMID 18383634. 
  23. ^ Olsen DM, Kane RL, Proctor PH (April 1976). "A controlled trial of multiphasic screening". N. Engl. J. Med. 294 (17): 925–30. doi:10.1056/NEJM197604222941705. PMID 1256483. 
  24. ^ Knox EG (December 1974). "Multiphasic screening". Lancet 2 (7894): 1434–6. doi:10.1016/S0140-6736(74)90086-5. PMID 4140342. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(74)90086-5. 

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