General medical examination
Encyclopedia
In medicine
, the (annual) general medical examination is a common form of preventive medicine
involving visits to a general practitioner
by asymptomatic
adults on a regular basis. This is generally yearly or less frequently. It is known under several other names, such as the periodic health evaluation, annual physical, comprehensive medical exam, or preventive health examination.
The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer
, or regular visits for people with certain chronic medical disorders (for example, diabetes
). The general medical examination generally involves a medical history
, a (brief or complete) physical examination
and sometimes laboratory
tests. Some more advanced tests include Ultrasound and mammography.
, and some notable health organisations recommend against annual examinations. The American Cancer Society
recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20. It is commonly performed in the United States and the United Kingdom, whereas the practice varies among mainland European countries.
A systematic review
of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol
screening, and faecal occult blood tests) and less patient worry. Evidence supports several of these individual screening interventions. The effects of annual check-ups on overall costs, patient disability
and mortality
, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive. A recent study found that the examination is associated with increased participation in cancer screening.
The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge. Despite guidelines recommending against routine annual examinations, many family physicians perform them. A fee-for-service
healthcare system has been suggested to promote this practice. An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient. This means choosing between a wide variety of tests.
The arguments for and against are similar for many other screening
interventions. The possible advantages include detection and subsequent prevention or early treatment for conditions such as high blood pressure, alcohol abuse
, smoking
, unhealthy diet
, obesity
and various cancer
s. Moreover, they could improve the patient-physician relationship and decrease patient anxiety
. New York doctor finds that more and more private insurance companies and even Medicare include annual physical in their coverage. Some employers require a mandatory health checkup before hiring a candidate. Most surgeons will ask a patient for his or her recent general medical examination results in order to proceed with the surgery. Disadvantages cited include the time and money that could be saved by a more targeted screening (health economics
argument), a possible increased anxiety over health risks (medicalisation), overdiagnosis
and harm resulting from unnecessary testing to detect or confirm medical problems.
, and periodic school health examinations. The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine
. Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, the (annual) general medical examination is a common form of preventive medicine
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
involving visits to a general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
by asymptomatic
Asymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
adults on a regular basis. This is generally yearly or less frequently. It is known under several other names, such as the periodic health evaluation, annual physical, comprehensive medical exam, or preventive health examination.
The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
, or regular visits for people with certain chronic medical disorders (for example, diabetes
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
). The general medical examination generally involves a medical history
Medical history
The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
, a (brief or complete) physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
and sometimes laboratory
Medical laboratory
A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
tests. Some more advanced tests include Ultrasound and mammography.
Usefulness
Although annual medical examinations are a routine practice in several countries, it is only partly supported by scientific evidenceEvidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, and some notable health organisations recommend against annual examinations. The American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20. It is commonly performed in the United States and the United Kingdom, whereas the practice varies among mainland European countries.
A systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
screening, and faecal occult blood tests) and less patient worry. Evidence supports several of these individual screening interventions. The effects of annual check-ups on overall costs, patient disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
and mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive. A recent study found that the examination is associated with increased participation in cancer screening.
The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge. Despite guidelines recommending against routine annual examinations, many family physicians perform them. A fee-for-service
Fee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care...
healthcare system has been suggested to promote this practice. An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient. This means choosing between a wide variety of tests.
The arguments for and against are similar for many other screening
Screening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
interventions. The possible advantages include detection and subsequent prevention or early treatment for conditions such as high blood pressure, alcohol abuse
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
, smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
, unhealthy diet
Reference Daily Intake
The Reference Daily Intake or Recommended Daily Intake is the daily intake level of a nutrient that is considered to be sufficient to meet the requirements of 97–98% of healthy individuals in every demographic in the United States .The RDI is used to determine the Daily Value of foods,...
, obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
and various cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s. Moreover, they could improve the patient-physician relationship and decrease patient anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
. New York doctor finds that more and more private insurance companies and even Medicare include annual physical in their coverage. Some employers require a mandatory health checkup before hiring a candidate. Most surgeons will ask a patient for his or her recent general medical examination results in order to proceed with the surgery. Disadvantages cited include the time and money that could be saved by a more targeted screening (health economics
Health economics
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...
argument), a possible increased anxiety over health risks (medicalisation), overdiagnosis
Overdiagnosis
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is the least familiar side effect of testing for early forms of disease – and, arguably, the most important...
and harm resulting from unnecessary testing to detect or confirm medical problems.
History
The roots of the periodic medical examination are not entirely clear. They seem to have been advocated since the 1920s. Some authors point to pleads from the 19th and early 20th century for the early detection of diseases like tuberculosisTuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, and periodic school health examinations. The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
. Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.
External links
- Health Checkup - from MedlinePlusMedlinePlusMedlinePlus is a free Web site that provides consumer health information for patients, families, and Health care providers. The site brings together information from the United States National Library of Medicine, the National Institutes of Health , other U.S. government agencies, and...