Annual Physical
An annual physical, often referred to as a health maintenance visit or routine checkup, is a preventive care measure aimed at maintaining health and detecting potential illnesses before symptoms manifest. The practice of annual physicals in the United States began in the early 20th century, evolving from a time when people only visited doctors when gravely ill. By the mid-20th century, annual physicals became commonplace, encouraged by organizations like the American Medical Association. However, over the years, the approach to these examinations has changed significantly, driven by evolving medical guidelines and research.
Today, the emphasis during an annual physical is not solely on routine tests but also on patient behavior and lifestyle factors that influence health outcomes. Physicians assess health through patient interviews and physical examinations, focusing on factors such as diet, exercise, and other habits. While the frequency and nature of recommended screenings have become more personalized based on age, gender, and health risks, annual physicals are no longer uniformly suggested for all adults.
The U.S. Preventive Services Task Force has played a crucial role in reshaping these guidelines, leading to a more tailored approach to preventive care. Additionally, recent legislation has reinforced the importance of preventive services by requiring insurance coverage for these visits. Overall, the annual physical serves as a vital opportunity for individuals to engage with their health proactively, promoting an informed and health-conscious lifestyle.
Annual Physical
The annual physical is also known as a health maintenance visit, routine physical, periodic examination, or regular checkup. No matter what its name, its purpose is preventive care (preventive medicine). Preventive care can help avoid illness and improve personal health. Regular exams with a physician can help check for illnesses before symptoms appear; this encourages a healthy lifestyle, which is the cornerstone of preventive care.
Regular physical exams may not always be annual events. Annual physicals were once standard, but that is no longer the case. In the 1980s, health experts changed their attitudes about what constitutes best practices for routine physicals. In the past, guidelines recommended that all adults be examined once a year and undergo the same set of diagnostic tests, regardless of health, family history of disease, or other risk factors. Today, experts may recommend less frequent exams and screening tests, based on age, gender, and personal risk factors.
Brief History
The annual physical in the United States is rooted in the early twentieth century. At the start of the century, people typically saw a doctor only if they were gravely ill, injured, or giving birth. By the 1920s, the concept of health examinations to detect illnesses prior to a person becoming sick had been introduced. Both the American Medical Association (AMA) and the American Public Health Association (APHA) advocated annual health examinations for all people. The APHA campaigned with the slogan, "Have a health examination on your birthday." The annual physical gained the support of the public, which considered detecting serious illnesses before symptoms appeared an ideal way to stay healthy. By the 1940s, annual physicals were the norm.
Over time, however, some medical professionals questioned the efficacy and cost-effectiveness of annual physicals. It was evident that screening could not detect all possible illnesses. A person could have an annual physical and experience a brain aneurism a short time later. In addition, screening sometimes resulted in false positives, or test results that falsely indicated a person had a serious illness. This resulted in additional medical testing that was unnecessary and costly. It also created unwarranted stress for the patient.
By the 1980s, concerns about the value of annual physicals had grown, and the US Preventive Services Task Force (USPSTF) was commissioned to examine the issue. It evaluated the screening tests used by physicians and determined that many of the tests did nothing to improve a person’s health, or lengthen their survival in case of illness. Based on these results, the USPSTF issued the Recommendations for Primary Care Practice report in 1989 that revolutionized preventive care. Past guidelines had recommended that all people receive the same set of screening tests every year, regardless of health, family history of disease, or risk factors. The new guidelines recommended screening for diseases based on age, gender, and other personal criteria. The new guidelines also recommended less frequent checkups, finding no medical evidence to support a physical every year.
Many medical professionals concur with the USPSTF’s call for less frequent physicals; however, there is some disagreement among physicians and medical associations as to how often and under what circumstances specific screening tests should be performed. For example, the USPSTF recommends mammograms to detect breast cancer every two years for women between the ages of fifty and seventy-four, while the American Cancer Society recommends annual mammograms for all women in this age group.
In 2010, preventive care was strengthened with the passage of the Patient Protection and Affordable Care Act. It required health insurers to cover all costs for preventive care as of 2015.
Annual Physical Today
The annual physical has shifted from a battery of screening tests to preventive services based on a patient’s needs. Perhaps the biggest change in routine physical examinations is the emphasis on patient behavior. Physicians recognize that many illnesses, such as diabetes, heart disease, and liver disease, are affected by diet, exercise, and tobacco and alcohol use. A primary goal of the routine physical is to counsel patients on how they can change their health through their behaviors.
During an annual physical, a physician assesses a patient’s health and risk for disease through an interview and physical examination. The interview includes detailed questions about the patient’s medical history and behaviors and family medical history. The physical examination generally includes: taking measurements of the patient’s height, temperature, weight, and blood pressure; listening to the heart and lungs; pressing against the patient’s abdomen; and examining the eyes, ears, and nose.
The physician also discusses any health concerns with the patient and counsels the patient on lifestyle choices and behaviors.
Overview of Screening Tests Guidelines
A physician may order medical screening tests based on the patient’s age, gender, and health risk as recommended by the USPSTF. The following is a brief overview of those guidelines.
Adult men and women between the ages of eighteen and forty-nine should have their blood pressure taken at least once every two years. Women ages twenty-one to thirty-nine should have a Pap test every three years, and women from ages forty to forty-nine, every five years. Women aged twenty-four and older who are sexually active should be tested annually for chlamydia. Both men and women with high blood pressure should be screened regularly for diabetes; persons with a risk for heart disease should be screened regularly for cholesterol; and persons who are sexually active should be screened regularly for the human immunodeficiency virus (HIV) and syphilis.
Men and women between ages fifty and sixty-four should have their blood pressure tested every two years. They should also be screened for colorectal cancer. The frequency of the latter will vary based on a patient’s medical history. Women in this age group should have a mammogram every two years, have a Pap test every five years, and have a bone mineral density test if they are at risk for osteoporosis. Both men and women who are at risk for other illnesses, such as sexually transmitted diseases, heart disease, and diabetes, should also have screening tests.
Men and women over age sixty-five should have their blood pressure tested every two years and be screened for colorectal cancer up to the age of seventy-five. Women should have a bone mineral density test at least once a year and a mammogram every two years, up to the age of seventy-five. Men should have an abdominal aortic aneurism screening at least once.
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