Physical

In anticipation of my physical, and partly to assuage fears that the post-big four-oh one would entail uncomfortable things, I sleuthed around for things on what to expect, thinking. Clearly I’ve been watching too many episodes of House.

The American Academy of Family Physicians[1] has six classifications for their recommendations of common “clinical preventive services:”

• SR – Strongly recommended: there’s a net gain, it’s cost effective. Vaccines top the list: MMR[4] (despite the anti-vaccination lunacy), tetanus booster, and diptheria/pertussis. Blood pressure is always/easily checked. Since I’m over 35, they want to check lipids (cholesterol and triglycerides). Anticipating this, I fasted prior to the appointment. It’s logistically unfortunate they don’t do the tests and process the results before the doctor visit, because I would like the option of asking what the numbers mean.
• R – Recommended: moderate benefit or moderate evidence. There were a lot of these. Rather than sifting through the conditionals (e.g., “for women over 65 years of age”), it was easier to consult the male[2]- or female[2]-specific charts.
• NR – No recommendation: there are only four of these in the 15 page list. The only one I’d heard of was screening for chlamydia in pregnant women over 26 years old.
• RA – Recommended against. I wasn’t entirely surprised they recommend against taking beta-carotene supplements. However, one that did turn my head was the recommendation against routine screening for testicular cancer[6], especially with the Lance Armstrong awareness campaigns[5].
• I – Insufficient evidence to make a recommendation either way. This was one area I was surprised: prostate[7] and skin cancer[8] screening fall into this category.
• HB – Healthy behavior that’s desirable, but a physician’s advice and counseling might not effective. For example, physical activity is recognized as beneficial.

Like the physical I had a few years go, this was easy:

1. Multiple verification of my name and birth date, despite electronification of medical records for the last three years.
2. Nurse measures my height, weight and blood pressure. The only amusing part was the wall-mounted ruler was done incorrectly. Or I shrunk 2 1/2 inches since last year and just didn’t notice.
3. Doctor (re)introduces himself and went through the scant electronic record as I watched over his shoulder, attempting to offer helpful commentary. Then he scanned the form and asked some ice-breaker questions. I had him laughing pretty hard. (And I still had my clothes on!)
4. The doctor looked in my ears, mouth. Yay, no ear wax buildup!
5. He listened to internals. This was probably not a good time to get him laughing again.
6. Turn my head and cough. (I maintain this is far preferable to the stirrups.)
7. Quiz time! (My favorite part.) I think he remembered me from last time when he spotted my list of questions. (I have his attention, I’m going to ask.) At the top of the list was the one about snapping, crackling and popping. Answer: “There really hasn’t been much research done. As long as it doesn’t cause pain, you probably shouldn’t need to worry about it.” Second question about general random achiness. Answer: “It’s normal for your age. You’ll get used to it.”

Pending normal results of the various standard blood tests, I’m hale. I do sense a market opportunity for minty, chewable aspirin.

Sources:

• [1] Summary of Recommendations for Clinical Preventive Services, revision 6.4. American Academy of Family Physicians.
• [2] AAFP Age Chart for men, women
• [3] Recommended Adult Immunization Schedule, American Academy of Family Physicians.
• [4] Vaccines and Autism, Center for Disease Control
• [5] Testicular Cancer Information and Support
• [6] Screening Testicular Cancer, Agency for Healthcare and Research Quality (AHRQ), Department of Health and Human Services (DHS)
• [7] Prostate Cancer Screening, AHRQ.
• [8] Skin Cancer Screening, AHRQ.