Medical Perspectives | Others

July 13, 2020



Doctor John V. Jiao, RMT, MD

In the modern occupational health setting, an Annual Physical Examination (APE) is a vital tool in order to verify if a worker is in good health or needs some medical attention. For occupational health physicians, thorough history, physical examination, and analysis of laboratory results are crucial to give the appropriate classification regarding fitness to work.

In evaluating each patient, the responsibility falls on theprimary care physician to manage areas as diverse as referrals, quality measures, avoidable admissions, and the increasing burden of chronic disease. Other challenges include reviewing consult notes, following up on imaging, laboratory, and other results ordered in other settings.

Recent debates and studies regarding the importance of the APE suggest that preventive services can be effectively delivered without the interpersonal touch of a dedicated medical visit. Additionally, many factors propose that actual exam is not very helpful in discovering problems and may lead to unnecessary tests. However, in the occupational health setting, these examinations give overview of the patient’s health status. Moreover, it also offersa chance for a physician to talk about any ongoing pain or symptoms that patientsare experiencing or any other health concerns that they might have.

The opportunity to discuss important public health issues and encourage healthy behaviors that can improve personal and societal outcomes and lower health care costs is also of importance when doing an APE. Examples include assessment and counselling on smoking, alcohol dependence, diet, and exercise. Discussion of advance directives is also better conducted at a preventive visit rather than during an acute illness when decision-making capacity can be impaired. The ability to focus these discussions on individual patients’ preferences, lifestyles, and risks is more effective than generic public health messages

Age and disease risk are also additional factors considered when to get an APE. The age of 50 years old is the recommended time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer or other risk factors may need to be screened before age 50.

For some women aged40 and above, an annual mammogram screening for breast cancer is recommended. The American Cancer Society recommends that Women ages 40 to 44 should have the choice to start mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year while women 55 and older should have mammograms every 2 years or can continue yearly screening. Women should talk to their doctor or other health care professional about when to start and how often to get a mammogram. Women should weigh the benefits and risks of screening tests when deciding whether to begin getting mammograms at age 40.

In summary, the significance of an annual physical examination can be fully maximized when accompanied by a focus on the key clinical skills of history taking, physical examination, and evidence-based preventive care. Adding tests for which there is no evidence raises costs, and is not an effective mechanism for detecting asymptomatic conditions for which routine screening is not indicated.

Primary care physicians that evaluate APEs must be knowledgeable and confident in the evidence-based care. They should know when to refer certain cases to other specializations for further evaluation and management. Furthermore, the relatively small investment in doing an APEcan be quite beneficial in order to avoid unnecessary admission, to advert emergency department visits, and to prevent possible costly illnesses in the future.

References:

  • Shein DM, Stone VE. The Annual Physical: Delivering Value. The American Journal of Medicine, Vol 130, No 5, May 2017
  • Ratini M, Annual Physical Examinations,(Update October 14, 2016).  Accessed at (https://www.webmd.com/a-to-z-guides/annual-physical-examinations#1)

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