"What All Do I Need Done?"

When I see patients for general physicals and check-ups I follow a certain "protocol" or check-list of items in order to be complete and comprehensive.  This in turn allows me to put any acute issues in proper context and helps me help you develop an appropriate plan for healthy living.

I usually start with obtaining a history of your previous medical problems and surgeries.  We will then discuss medical issues that run in your family.  From there, we'll get into the sometimes-difficult but always important social history discussion.  This includes smoking, alcohol, drug, and sexual habits and an overview of your work and home life.  Rounding out the "history" portion of things is a general review of systems – a list of questions designed to see if anything is physically bothering you from head to toe.  Importantly, I screen for depression and mood disorders during this portion.

After the review of systems comes the actual physical exam.  I first review the vital signs (including blood pressure) taken by my medical assistant and then check you over from head to toe.  The physical exam is usually generalized, but I will focus on areas that came to mind during the preceding portion of your visit.

The last piece is my assessment of and plan for you based on my findings.  At the conclusion of the assessment and plan is a line item dubbed "health maintenance."  Health maintenance items tend to be the portion of the assessment that is second-nature and reflexive on the end of a good internist, but they are the things that you are often times most concerned about during a general check-up.  Heath maintenance items essentially encompass the response to the following:

• "I'd like general blood work."
• "I wanna be checked for everything."
• "What all do I need done?"
• "I haven't seen a doctor in a while and wanted to make sure that everything was okay."

Listed below are age-appropriate health maintenance items that should be covered during your doctor's visits.  I have included how often you should be seeing your doctor and what the focus of those visits should be.  Focus on your approximate age, but be familiar with all of these.

25

The big thing at this age is foundation-setting for a healthy life. Our discussion will center on good eating and exercise habits and how to maintain a healthy weight.  Smoking and drinking habits will be an important discussion.  We will also discuss mood and balancing things like work and family.  At 25 our major goal is to prevent medical issues down the line.  If you are female, I'll encourage you to (and help you) find a good gynecologist to add to your team of healthcare providers.  Once done, I usually let her/him handle all of your gynecologic issues.

If not done in the last several years, I will check a metabolic panel* and a lipid panel^.  These are not things that will need to be done on a yearly basis unless abnormalities are detected.  However, these tests will give me a good indication of the state of your general health, including your diet and exercise habits.  Depending on your specific concerns and symptoms I will also check a baseline blood count# and screen for thyroid disease (especially if you are female).  If you are single and/or have not had an STD test in recent years, I will also screen for HIV and syphilis and, when appropriate, chlamydia/gonorrhea and herpes.

You should start seeing me yearly or as-needed.

35

My 35-year-olds are usually still pretty energetic and generally healthy.  If you haven't already started seeing me at least on a yearly basis, I will now encourage you to do so.  35 is about maintaining the healthy habits discussed at 25 and balancing the challenges of work, family, personal life, and a body that does not recover as well as it did 10 years ago.  Under most circumstances there will now be people depending on you, so taking proper care of yourself will be important.

The blood work that I intermittently ordered on you in your 20s begins to be checked with increased frequency, as you are now at an age where signs of blood pressure and cholesterol issues start to make themselves known.

45

Now's the time I start getting strict on patients.  At 45 you are knocking on middle-age's door.  While you are hopefully still completely healthy and not taking any medicines, it is not uncommon for you to have 1 medical issue, such as high blood pressure or cholesterol issues.  This is an important time because you are at a place where your lifestyle heavily influences whether or not you are going to go down the path to healthy living or recurrent medical issues.  Diet and exercise habits will dominate our discussion, and you will likely get introduced to baby aspirin.  We will also touch base on stress reduction and long-term health goals.

We are now doing blood work yearly. This primarily consists of a metabolic panel and a lipid panel.  Depending upon your medical history and past blood-draws, I will also check blood counts more regularly.  In addition, checking thyroid function on a semi-regular basis will be important, particularly if you are female.

If you are male, we will start having race- and risk-factor-specific discussions regarding prostate cancer screening.  Our decision to start yearly screening with a rectal exam and PSA blood test will be individualized.  If you are female, we will already have started discussing and/or obtaining yearly mammograms to screen for breast cancer.

55

You are my most challenging but favorite patient age.  Your body doesn't work as efficiently as it did 30 years ago, and it is more difficult for you to recover from rigorous activities and body stressors. Yet for some reason, you act like you don't understand why.  You are 55, not 25.  I hate saying it as much as you hate hearing it, but you force me to because you continually ask me why this or that hurts despite you not doing anything too far outside of the norm.

My goal is for you to embrace and celebrate where you are in life and to get you to continue doing the things that preserve good health.  You will likely only have 0 to 1 chronic medical issues, but you are going to have to work hard and be disciplined to keep things that way.

We will be checking the same labs we did a decade ago but definitely on a yearly basis.  Specifically, screenings for diabetes will become very important, and your LDL cholesterol level goals will likely start to change.  It will be my job to properly inform of these things and help you make the right choices regarding treatment.

You SHOULD have already had at least one colonoscopy starting at the age of 50.  A colonoscopy is an endoscope that screens for signs of colon cancer.  It is recommended that all adults get this done at least every 10 years starting at the age of 50.  If you have a family history of colon cancer, we start this process at a younger age.  Otherwise, you will continue the same yearly cancer screening tests, such as prostate checks or mammography and PAP smears, as a decade ago.

65

Despite being older than my parents, we are now good friends.  You will likely start seeing me at least twice yearly, because you will likely have 1 or 2 chronic medical issues and/or be at risk for several others.  Nevertheless, this should be a good time in life for you.  You are close to retiring (if not retired already), your financial dependents list is dwindling, and you are learning that being a grandparent is way more easy and enjoyable than being a parent.  At this age there is not a ton we can do to prevent you from medical issues, but our lifestyle decisions for you will definitely dictate how many pills (if any) you need to take every day.

You will be getting those blood tests that we started 40 years ago every several months to a year depending on your underlying medical conditions and risks.  In addition, I will also start checking your vitamin D level, B12 level, and, if you are male and your symptoms dictate, your testosterone level.

You should be commencing with the same cancer screening tests as last decade with a couple of additional screening tests.  If you are female we will start checking your bone density on a regular basis, and if you are male (and smoked regularly for a period of time) we will screen you for an abdominal aortic aneurysm.

75

75 is not much different than 65 in terms of the healthcare you will receive.  Generally, we will be checking the same labs and screening tests and seeing each other at the same interval of time.  I will still be encouraging you to eat right and properly exercise, but our focus will be on you working out smart as opposed to hard.

You may have 2 or more physicians for various health issues at this age, and I will have helped you assemble this team over the previous years.

At this age you will find me asking you simple, silly questions from time to time.  My intent will not be to make small talk. Rather, I will start looking more closely for signs of dementia and depression.

85+

First and foremost, congratulations. Getting here took more than luck and chance.  You did many of the right things early on, and the things you did wrong worked in your favor for whatever reason.  We will likely be seeing each other at least 3 or 4 times yearly, and you will usually bring someone with you to the office. Our focus will shift away from prevention and more towards maintenance and quality.  I will not make any major medical changes to your medication and therapy regimens in an effort to keep the ship moving forward steadily.

While we will likely be checking the same basic labs as 60 years ago--blood counts, metabolic panel, and lipid panel, with vitamin D--we will start phasing out cancer screening tests.  You read correctly!  Unless situation-specific, we will stop doing colonoscopies, mammograms, PAP smears, and prostate checks.  The thought is that these cancers will likely not be your cause of death at this age.  Yet and still, we will continue to minimize your risk of heart attack, stroke, kidney disease, lung disease, and diabetes.  I will also continue to regularly screen you for mood disorders and dementia.

What's very important at this age is making sure that you are living in a comfortable yet safe environment.  Unfortunately, most of the time this means that it would be unwise and unsafe for you to live alone.  One of the toughest discussions we will have will be how and where to transition your living situation to one with assistance.

*A metabolic panel looks at liver and kidney function and basic electrolytes and screens for diabetes with a glucose level.

^A lipid panel looks at bad cholesterol/LDL, good cholesterol/HDL, and triglycerides.

#A blood count looks at hemoglobin/hematocrit, white blood cell counts, red blood cell counts, and platelets “(blood clotters”). This in essence screens for anemias and other hematologic (blood) disorders such as leukemias and lymphomas.