Medical Checkups
Medical Checkups
Well Worth Penciling In
Nobody's particularly wild about lying down half-naked on a cold table to have their bodies examined by a near-stranger. Yet we do it, because we know that medical checkups are good for us.
In fact, each year American women make roughly 130 million more visits to the doctor's office than men do. And we also live an average of seven years longer than men. Some experts say that these two statistics are by no means unconnected.
By getting a regular checkup, you and your doctor can keep an eye out for developing problems and perhaps put a stop to them. Just as important, meeting with your doctor can give you both a chance to discuss certain lifestyle factors that can make the difference between a long and vigorous life or a short one plagued with problems you shouldn't have until you're 85.
Choosing Dr. Right
Getting a checkup seems simple enough, but where it can quickly start to resemble the quest for the Holy Grail is when you start looking for a doctor. Who's qualified? What should you, as a smart consumer, be looking for?
"Basically, anyone who holds himself out by training and practice as a primary care physician should be fully qualified to take care of checkups for normal, healthy adults," says Douglas Kamerow, M.D., director of the Clinical Preventive Services Staff for the Office of Disease Prevention and Health Promotion in the U.S. Public Health Service. "But, in my opinion, there are really only two groups that are qualified by their training to do so: general internists and family physicians."
Some experts in women's health, however, would narrow the list even further and add a few provisos. "My number-one choice would be a general internist," says Lila Wallis, M.D., clinical professor of medicine at Cornell University Medical College, former president of the American Medical Women's Association and founder of the National Council of Women's Health in New York City. "And not just any general internist, but one who has had special training in office gynecology and the psychological needs of female patients."
According to Dr. Wallis, a family practitioner would do if a general internist was not available. "The only reason he or she wouldn't be my first choice is that the family practitioner has to learn so much more about children that it could dilute the amount of time spent keeping abreast of women's health developments."
And gynecologists, who many women make their first choice, actually come in third. "While general internists and family practitioners already have a firm knowledge of the rest of the body, gynecologists specialize specifically in women's sexual organs and reproductive tract," notes Dr. Wallis. "This gives them far more to learn than the other two to become a primary care physician."
Specialization is not something you want to overlook, adds Dr. Wallis. "Many internists have areas of specialization such as cardiology or hematology. But you want to be careful that they aren't neglecting continuing education courses in women's health issues to the advantage of their other interest."
How Often Should You Go? The annual physical. When most people think of a checkup, they tend to picture a yearly barrage of pokes, prods and needle pricks that are done like clockwork whether they're needed or not. This has a lot to do with tradition. Back in 1922 the American Medical Association (AMA) first endorsed the annual examination of healthy people, and for many years after it was standard practice. "It was only in 1983 that the AMA withdrew support for this concept," says Douglas Kamerow, M.D., director of the Clinical Preventive Services Staff for the Office of Disease Prevention and Health Promotion in the U.S. Public Health Service. In this brave new world of checkups, the current medical wisdom is that for healthy people, a more tailored program of preventive services can be effective. In layman's terms, this means fewer checkups will do just as well as the time-honored annual physical. If you have no serious ailments that need monitoring, most experts advise that you touch base with your primary care physician every three to five years from age 30 to 39, every two to three years from age 40 to 49 and, past 50, every year. But, adds Dr. Kamerow, a pap smear is still recommended annually regardless of your age if you have shown any potential signs of trouble in the cervix or if you have multiple sex partners. |
Preparing for Your Checkup
Miss Marple may have been able to get to the truth based on the merest of clues, but your doctor needs solid information. You can best provide that information by doing a bit of homework before your visit.
Keep a food log. When it comes to health habits, the murkiest information tends to surround diet. How often do you really notice what you eat throughout the day: that mid-morning candy bar, a bag of chips in the car. It all adds up, but it's easily forgettable when making a report on your eating habits to your doctor. And what in reality is not the healthiest of eating habits suddenly becomes squeaky clean in the doctor's office.
"If you know you're going in for a checkup and plan on discussing diet, it's not a bad idea to keep a precise food log for a week beforehand," suggests Dr. Kamerow. "Don't change your eating habits, just keep track of them. It's the little forgettable things like snacks that add up to a lot of dietary fat, and it's these things that you'll need to focus on when talking to your doctor."
Climb your family tree. Coming up with a complete family history of illnesses will also require a little attention and, depending on what you discover, may affect the types of tests you'll need. "People with a family history of certain health problems may be at greater risk of developing them, and it's reasonable to screen these people more regularly or earlier for these diseases," says Dr. Kamerow.
While there may well be hundreds of diseases that can be passed along genetically, there are, in fact, only a few that you really need to be concerned with. "Breast cancer is a primary concern," says Dr. Kamerow. "The U.S. Preventive Services Task Force does not recommend mammograms before the age of 50. But one may want to make an exception for women who are at high risk by evidence that their mother or sister had it, especially if the cancer was pre-menopausal."
Osteoporosis is another concern for women. "A family history of osteoporosis might predispose me to suggest a bone mineral density study at menopause, which I might not normally use routinely," says Dr. Wallis. A family history of heart disease or any cancer including ovarian, colon, breast, uterine and pancreatic should also be discussed with your doctor.
Prepare your files. You'll want to make sure your doctor has records from any other physicians you may have visited. You'll also want to inform her of any medications you are taking and any problems that you feel you may be experiencing because of them. You may also want to prepare a list of current health complaints complete with symptoms and dates if possible.
Getting the Most from It
You've picked the doc, done your homework and now you're cooling your heels in the waiting room listening to a Muzak version of "Eleanor Rigby." What lies in wait for you beyond the smiling nurse? Or, more to the point, what should happen in the examination room to make for a perfect checkup?
"One of the most important components of the physical is a breast examination," says JoAnn E. Manson, M.D., co-principal investigator of the cardiovascular component of the Nurses' Health Study, associate professor of medicine at Harvard Medical School and co-director of women's health at Brigham and Women's Hospital, both in Boston. "After that and, of course, a pelvic exam and pap smear, there is a whole list of options that can be performed, some more important than others."
Dr. Manson strongly suggests that your doctor perform the following:
* Measure your blood pressure, weight and height.
* Inspect your tongue and gums for any signs of oral cancer or need for dental care.
* Check the artery in your neck for pulse and listen for bruits--abnormal sounds that can indicate a clogged artery.
* Inspect the neck area for thyroid size and nodules for possible cancer.
* Examine your skin, especially in sun-exposed areas, for any signs of skin cancer.
* Listen to your chest for heart sounds and lung congestion, crackles or wheezes.
"In some people, especially those who are young and healthy, it may be less important to check the liver, kidneys, spleen and reflexes and test for signs of nerve damage," says Dr. Manson. "The need for many of these tests depends on age, prior medical history and risk factors. So not all women should expect to have all these tests performed at every checkup."
What else might you expect?
"It's also not a bad idea to do a nonfasting total blood cholesterol screening, and this is especially needed if there is a history of heart disease in the family," says Dr. Kamerow.
Pap smears are also standard issue. Most of the experts recommend an annual Pap smear. Regular Pap smears are especially important for sexually active women outside of a monogamous relationship, because many physicians feel that the human papilloma virus, a sexually transmitted disease, is a major cause of cervical cancer. If your sexual activity is not directed toward only one person, Dr. Kamerow suggests that you get routine screenings for other sexually transmitted diseases, such as chlamydia, as well.
When it comes to the more exotic blood and urine tests, electrocardiograms and x-rays, the U.S. Preventive Services Task Force does not routinely recommend them for the healthy patient.
After Menopause
As we reach menopause, one test might be added to our routine checkup. "There is no better way of determining how a woman's bones will fare later than a bone mineral density study at menopause," says Dr. Wallis. "If the patient exhibits any risk factors, such as a family history of osteoporosis, a pale complexion, red or blonde hair, a northern European origin, lack of exposure to sun, lack of exercise or a lack of calcium intake, I would definitely suggest she undergo it."
Taking anywhere from five minutes to a half-hour (depending on the technology used), a bone mineral density study is a painless, noninvasive scan performed by machines that use low-dose radiation to measure bone mass.
The other change in checkup routine happens at 40. At that age, most doctors recommend regular mammograms for women. "Some would also recommend a fecal occult blood test and a sigmoidoscopy to screen for colorectal cancer," says Dr. Kamerow.
Of the three tests, the fecal occult blood test offers the least amount of patient discomfort, only requiring a stool sample to be brought from home so that the physician can check for blood as a possible symptom of colorectal cancer. Mammograms, while nothing more than low-dose breast x-rays, may cause some discomfort when the breast is firmly compressed between two plates. Finally, the sigmoidoscopy. It's not pleasant. A thin, hollow, lighted tube is inserted into the rectum and lower part of the colon to look for precancerous polyps.
Taking the Doctor's Advice Home
Take a deep breath and relax. The poking and prodding are behind you. Now it's time to direct the hard light of science onto your lifestyle. "Outside of the few tests and shots you should get, the most important thing that can be done at a checkup is to team up with your doctor and take stock of your health habits," states Dr. Kamerow. The big four topics of discussion should be exercise, diet, sexual practices and vices such as smoking and drinking, he says. "Poor habits in these areas contribute mightily to the leading causes of disease and death in this country, and yet they are the very things we cannot test or fix with medicine."
If you smoke, talk to your doctor about ways to quit. The same goes for "recreational" drugs, excessive use of medications, such as sedatives and diet pills, and alcohol abuse. If you are prone to adventurous sex, have a sobering conversation on safe sex as well as the potential dangers involved in bed hopping. Diet? Haul out that food diary and go over it in detail. As for exercise, ask your doctor for tips to incorporate more physical activity into your life.
Don't worry about taking up too much of your doctor's time. "The most important thing that goes on at a checkup is the counseling and the activity that the patient then does because of that counseling," says Dr. Kamerow. "Doctors are beginning to realize that the most healing thing they can do is provide information and motivation."