Many tests, procedures, gadgets, and machines assess various aspects of health and wellness. They range from the hands-on physical examination to the use of sophisticated diagnostic tests. There is some debate, however, as to when and how often they are to be administered and how effective they are.



The Physical Examination

Until recently the annual physical examination was viewed as a normal and necessary part of health care. Now, considerable debate exists among medical experts as to who needs a physical examination, how often it is needed, and what it should include.

Critics believe that many of the routine procedures doctors use in a physical examination on healthy adults are virtually useless and that much of the touching, probing, thumping, and listening serves little purpose except to reassure patients.

Although many physicians are reluctant to eliminate the annual physical, the emphasis today is in the use of selective health examinations and periodic examinations. Selective health examinations are the practice of using specific tests for specific problems. The assumption is that tests are more useful if they are matched to specific complaints. Periodic examinations are assessments whose scope and timing are tailored to risk factors, age, and lifestyle .Rather than running a lengthy battery of expensive tests, the periodic exam includes only those tests that are warranted by the information coming from a thorough medical history and discussion of those lifestyle factors related to diseases. The assumption is that behavior and habits are the best criteria for predicting disease risk.

Criticisms of the comprehensive annual physical examination for a healthy adult are not meant to undermine the doctor-patient relationship. They simply cast doubt about the efficacy of the physical examination. However, this does not nullify the value of regular visits to the doctor. To the contrary, seeing a physician for a limited examination at regular intervals can be good preventive medicine.

How Often?

Healthy adults between the ages of 20 and 60 years should get a complete physical every 5 years. Yearly physicals are advisable for children under and adults over 60 years of age, even if they do not have symptoms. No group suggests a complete annual physical examination for adults in good health.

Regardless of age, individuals with a family history of heart disease, strokes, high blood pressure, cancer, and diabetes can benefit by periodic check­ups, even if they are in good health. The same is true for individuals whose health habits or occupation put them at higher than normal risk for chronic diseases and disabling conditions. Even in these cases, good judgment and discretion should rule the choice of tests to be included in the physical examination.