HI, I’D LIKE TO SET UP A PHYSICAL….

With so many of our patients now signing up with new insurance plans, one of the most common requests made of us as Family Physicians is to provide “a physical” for our patients. Of course as with anything, there is often confusion as to what “a physical” really means. So I thought I’d spend a bit of time (in this blog post) explaining or clarifying exactly what this means to us doctors, so that you the patient will be sure to have your expectations met during your visit.

When doctors engage our patients in the “annual physical” what we are really doing is performing a “Health Maintenance Visit” also known as a “Wellness Visit”. There is substantial scientific data suggesting that undergoing an annual Wellness visit with a consistent primary care doctor can improve health outcomes over time. During this visit your doctor will take into account your age, gender, body type, genetic (family) history, modifiable lifestyle factors (such as tobacco and alcohol use, diet and exercise), medications and supplements, and of course any chronic medical conditions you may have. After considering all of these variables, your doctor will help you decide which preventative interventions are suggested based on your personal profile. For example, a screening Colonoscopy would be recommended for everyone at age 50 regardless of risk factors to look for early signs of Colon Cancer. On the other hand, this test might be recommended earlier if there is a strong family history for colon cancer. Other screening tests (such as mammograms), laboratory tests (such as a cholesterol panel) and a host of vaccines are also recommended at various intervals based upon one’s personal profile as well.

One of the points of confusion that may arise is when a patient asks for active management of one or more of their medical problems during this wellness visit. Doctors are not really supposed to do this since the wellness visit is meant to be primarily focused on wellness and not illness. Furthermore, doctors are dis-incentivized to tackle areas of illness during these visits by insurance companies who simply do not reimburse doctors for the work they do with regard to non-wellness management. This is why you may have been told at a wellness visit by your doctor after you asked about a new or existing medical problem something like “we’ll need to discuss this at a follow up visit”. In this setting the doctor is not trying to put off your concerns, but rather is trying to keep the discussion focused on wellness and prevention during the limited face time you do have with your doctor. Happily, this annual wellness visit is paid for (often in full) by most insurance companies.

If I haven’t lost you yet, then you must be asking yourself what about the “physical exam” part, that old school idea of laying hands on a patient? Isn’t that part of this whole deal? Interestingly enough, there is no data that routine physical exams (when there are no specific symptoms to evaluate) improve long term health outcomes. That said, most doctors (including those at OFD) do perform a full physical exam during the Wellness Visit. In fact in spite of the data to the contrary, we physicians do periodically pick up new findings during these exams so you can expect the “physical” part to continue at the wellness visit.

I hope this explanation was helpful and will encourage you to carve out some time from your busy schedule, and make an appointment with your primary doctor once a year to help ensure many years of good health.

Michael Weizman, MD