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You can have many different kinds of interactions with our current health care system. It may be a blood pressure check with a nurse practitioner to tweak the dose of a medication, a trip to the emergency room for an acute injury or an office visit with a doctor for a persistent or worsening problem.

The most mundane yet still fairly common interaction is the annual physical. 
 

  Dr. Steven Bayer

While the literature is somewhat inconsistent, recent surveys indicate that 30 to 40 percent of adults in this country engage in this ritual. Annual physicals are covered under the Affordable Care Act free of charge.

As the practice of medicine and the means to fund it evolve in this country, this seemingly innocuous encounter has become a flashpoint of controversy. Medical journals as well as newspapers and magazines feature debates over its utility. 

The focus is usually on cost, which is relatively easy to calculate, and utility, which at times is even hard to define. Is the yearly checkup useful? Does it make a difference?

Doctors and patients may look at it differently, bringing their own information and even expectations to the encounter.

You should be prepared and organized for the exam.

 This is an opportunity to take stock of an important aspect of your life that often gets pushed into the background. Write down questions and health information in advance. Don’t count on the electronic medical record to provide all relevant information for your doctor.

Bring a complete list of current medications, including dose and the name of the prescribing physician. List any new medical problems that another physician is treating.

Expect to review yearly medical tests and other maintenance issues. Be sure to bring up any other concerns that no other health care professional is treating. Your doctor will ask pertinent questions, then give you a general physical exam. 

The doctor will pay special attention to any areas of concern you mentioned.

When finished, your doctor will review the exam, then address any new problems you brought up at the start of the visit. 

Crucially, your doctor should ask if you have any questions about your health or the plan of care. 

If you leave your doctor with an order for a test or procedure and you don’t know why, there has been a serious communication breakdown. Ask questions, and be clear about the plan.

You should leave with a plan to pursue an outstanding problem that includes a timeframe for following up, or information on healthy habits and a follow-up appointment for one year.

“What are some of the drawbacks of annual doctor visits? The details very depending on who you ask, but critics say that annual exams are costly in terms of time and money and do not produce a statistically significant change in patient morbidity and mortality.

Besides being a waste of health care dollars, unnecessary screening tests can lead to false positives and further testing that can injure a patient. 

The time a physician spends on a routine physical could be better spent seeing patients who are truly sick, thereby avoiding emergency room visits and costs.

Patients are increasingly dismayed by physician encounters that revolve around their doctor staring at a screen, asking questions and recording data that satisfies third party payers but seem irrelevant to the problem at hand. 

The actual exam is downgraded or minimized and in its place are a plethora of ultrasounds, scans and blood tests. This time should be a personal encounter, face to face and eye to eye, and all parties need to work to make this happen.

Insurance companies see you as a consumer of health care but your physician should not. Medicine is no longer purely an art and not yet totally a science, despite reams of contradictory research. It is important that your doctor know who you are when you are not sick so he or she can better judge if there has been a change in your health. 

As patients and doctors, we must be aware of costs and resources, but your health can be maintained and enhanced by a meaningful annual visit. Both parties share a responsibility to make that happen.
Your annual checkup can make a difference.


Steven Bayer, a Flossmoor resident, is a neurologist in practice at NWI Neurological Associates in Munster, Ind. This column was published in the February print edition of the Chronicle.

 

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