Dr. George Shaw, family physician, confers with nurse Ellen Baxter at his practice in Sandys. *Photo supplied
Dr. George Shaw, family physician, confers with nurse Ellen Baxter at his practice in Sandys. *Photo supplied
A question that has been debated for many years and still is: should everyone have an annual physical?

The origins of the practice, in the early part of the last century, apparently came from physicians doing examinations to see if people were fit enough to be sold life insurance.

In 1947, the AMA (American Medical Association) suggested that everyone should have a yearly check up, even when they were healthy.

It then became an accepted practice, which many follow to this day.

Studies in the 60s and 70s, however, showed that persons who have annual physicals did not live longer or have less illness than persons who did not have annual physicals.

More recently, with the advent of evidence-based medicine, and of financial and time constraints, there has been a move away from the practice.

Even so, many people continue to have a yearly check up. They are reassured by the fact that they do not have anything wrong.

So, does every healthy ‘twenty something,’ who has no specific complaint, need a yearly physical? Probably not.

I hasten to add that this applies to healthy young people, who have no ongoing chronic medical conditions.

Persons who have hypertension, diabetes, asthma or other chronic conditions should see their physicians a minimum of once a year.

Do my patients come for annual physicals? Many do. Interestingly, they are the ones who are already following a healthy lifestyle, doing the right things and looking after themselves. Many who should come, don’t.

There are certain tests and procedures that are accepted by the medical community as being important components of preventive medicine.

Some screening tests include screening for cervical cancer (PAP smear, or Papanicolau smear), prostate cancer (PSA, or prostate specific antigen and rectal exam), diabetes, colon cancer (fecal occult blood testing; possibly colonoscopy), mammography, bone densitometry and cholesterol testing. These are done periodically, and the timing of them is based on the age of the patient and the family history.

Much of what is included in an annual physical can be done at a regular visit.

Many physicians will use a regular visit to ask specific questions and to do a targeted physical examination.

So what things are important in an annual visit? 

For me, enquiring about significant family medical history, and about the traditional risk factors for heart disease and stroke (cardiovascular disease) are a priority.

These traditional risk factors include: family history, gender, smoking, hypertension, elevated cholesterol, diabetes, and sedentary lifestyle.

Specific questioning will vary by age and gender. If there is a positive family history of a specific condition, usually screening will be commenced earlier than would be recommended for a person with a negative family history.

Women

Women’s health exams include a check for a family history of gynaecologic malignancy, breast cancer or colon cancer, as well as for a history of cardiovascular disease.

Screening for cervical cancer (PAP) usually begins at age 18, or three years after becoming sexually active.

After two normal yearly exams, frequency can move to every three years. STD (sexually transmitted disease) screening for sexually active women should be yearly.

Cervical cancer has been shown to be caused by persistent Human Papilloma Virus (HPV) infection.

There are two vaccines available that protect against the vast majority of troublesome HPV types, and it is recommended that girls age 10 to 12 receive one of these vaccines, which will confer, hopefully, life-long protection.

It is noted that these vaccines can be given to women up to age 26. I have no idea why there is not more uptake on this. Perhaps there needs to be more dissemination of information.

Breast exams should be done at the time of the gynaecologic exam. Mammography usually starts after age 40, earlier if family history dictates.

Colon cancer screening should start at age 50, and can be done by yearly fecal occult blood testing, or colonoscopy every ten years. Again, timing would be influenced by family history.

Women are traditionally better at seeking medical attention than men. But there are signs of improvement, probably related to the heightened awareness of various conditions and advertising campaigns.

Men

Men’s screening will involve risk factors for heart disease and stroke, prostate cancer and colon cancer, and these will come into play at different ages.

Prostate screening should begin at age 40, and involves a PSA blood test and a digital rectal exam. Colon cancer screening is the same as for women.

Other topics to cover include avoidance of risky behaviour, immunizations history, eye health and mental health.

In summary, people are much more educated about health matters now and should be part of the process.

Making arrangements with your doctor to have a periodic health maintenance exam is a good idea, to be sure that all that can be done to maximize one’s good health is done.