Nothing Routine
There are new guidelines for your "annual" physical,
and you may need to get more involved.
RUTHAN BRODSKY
Special to The Jewish News
IV
hen her regular internist
died several years, Linda
Mandlebaum of
Bloomfield Hills started
looking for another physician. She
hasn't found a replacement.
"I see my gynecologist for an annu-
al Pap test and mammogram," says
Mandlebaum, who's in her late 40s.
"My blood pressure and urine are
checked and cholesterol levels ana-
lyzed. Since I'm healthy, I don't feel it's
urgent for a more extensive examina-
tion."
Her husband Frank hasn't had a
physical examination in five years. "I
shouldn't be so casual about the topic,
especially since I've reached 50, but
thank goodness I'm healthy and don't
have a need to see a doctor."
Barbara Katz of West Bloomfield,
in her mid-50s, intentionally doesn't
schedule annual exams other than a
regular visit with her gynecologist.
"Besides the internal exam and Pap
test, I feel my gynecologist gives me a
thorough, basic exam."
Frank may be a bit off the track,
but Linda and Barbara are not far
from one of the current viewpoints
which champions the end of annual
head-to-toe checkups because they
can't be counted on to provide early
detection of disease or prevention and
they cost. For some, the yearly check-
up is replaced by the
periodic health exam in
which specific tests are
fitted to an individual's
age, lifestyle and risk
factors for disease.
Taking a patient's medical history and
convincing her that losing weight and
exercising may prevent a stroke or
heart attack is deemed more impor-
tant than waiting until she needs an
angioplasty for clogged arteries.
Diane Levine, internist, clerkship
coordinator at Beaumont Hospital for
internal medicine students, and certi-
fied in geriatrics, agrees that getting
patients to assume a healthy lifestyle as
young as possible is important, but
she also says there's a need to be exam-
ined and tested at different times to
Katie Weishaus listens as
Dr. Panush discusses her
medical history.
Screening Tests
s
everal groups, including the
U.S. Preventive Services Task
Force, the American College
of Physicians, and the
American Cancer Society, make rec-
ommendations about who should be
tested for what and how often.
The following are tests doctors are
most likely to request for adults who
are generally in good health. Keep in
mind, however, that a group's recom-
mendation is not the final word but a
guide when it comes to preventive
medicine and screening.
• Blood pressure should be
checked at every doctor visit or at
least once every two years.
• Blood sugar should be tested in
individuals age 45 and older every
three years. People with known risk
factors for diabetes, such as obesity or
a family history, should be tested ear-
lier and more frequently.
• Colorectal cancer: People who
are at average risk by age 50 and older
can choose among hav-
ing an annual stool test,
sigmoidoscopy every
five years, a combina-
tion of the two or a
colonoscopy every 10 years.
• Cholesterol screening at age 35
for men and age 45 for women. Only
younger adults with coronary risk fac-
tors such as smoking, hypertension,
diabetes, or a family history of heart
disease are screened earlier.
• Immunizations: All adults need a
tetanus-diphtheria shot every 10 years
after the initial childhood series.
People who are 65 and older should
have a pneumococcal immunization
once and flu shots every season.
Women of childbearing age should be
given the Rubella vaccine once, but
not during pregnancy.
• Pelvic exam/Pap smear: Women
should begin this test every 1-3 years
beginning at age 18, or earlier if sexu-
ally active.
• Clinical breast examination:
Most major groups recommend that
women over 40 get an annual breast
exam by a physician. The American
Cancer Society advises women age
20-40 to have the exam every three
years.
• Mammography: Women over 50
should have a mammogram every 1-2
years to detect breast cancer. Some
groups" believethat women should be
tested by age 40.
• Prostrate cancer: Most groups
recommend that men 40 and older
have an annual digital rectal exam.
Some groups also recommend the
prostate specific antigen (PSA) test
regularly for Caucasian men 50 and
older and African-American men age
40 and older.
• Treadmill tests: An exercise stress
establish medical and physical bench-
marks.
For example, Levine says by the
time women are 18 years old even
those who are not sexually active
should have a Pap smear because that's
when the risk for cervical cancer
begins to increase.
"By the time a man or a woman is
20, it's a good idea to be established
with a physician," says Levine. "Then,
depending upon their medical history
and lifestyle, they should see their
physician periodically for blood pres-
sure screening and
Eg analysis of cholesterol
levels.
"If one of my
patients is 22, but
§ overweight and
smokes, I'll want to see
him on a more regular
basis. If another
patient shows no
test (an EKG taken
during exertion)
shouldn't be done
without good reason.
• Chest X-rays:
Most groups consider
them unlikely to
detect lung cancer
early enough.
• Osteoporosis screening: Recent
developments in radiology have made
it possible to identify osteoporosis
before bones are broken and to assess
the extent of individual risk. Some
groups recommend screening for at-
risk patients by age 40 and for other
women by age 50.
• Blood tests: Many routine blood
tests are useful and appropriate, while
others included automatically don't
do much good.
• Electrocardiograms: They are
considered useless for people who
don't show symptoms and are not
high risk. The test almost never
reveals an unsuspected problem.
Patients should have a single baseline
EKG for future comparison should
symptoms occur.
2/27
1998
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