Annual Physical Examination / Periodic Health Evaluation

The traditional stalwart of the doctor/patient relationship – the annual examination – has, of late, fallen a bit out of favor and has been replaced by the periodic “check up.” Strangely, both Medicare and commercial health insurance providers carve out an annual health maintenance examination as part of typical coverage. Private health insurers do so as a requirement of the Affordable Care Act (“Obamacare”). Coverage varies by insurance plan, so it is always best to check directly with your insurer but a list of preventive health care benefits is available at Heathcare.gov (link: https://www.healthcare.gov/preventive-care-adults/)

According to the US Preventive Task Force (USPFT), there are no strict guidelines for the optimal frequency of period visits.  For younger patients without chronic health conditions, even annual examinations may not be indicated. On the other hand, those with chronic health issues (such as diabetes) may have preventive evaluations up to four times a year. For adults above the age of 50 years, an annual health evaluation is recommended. For those who rarely see a clinician, such a visit may be their only opportunity to discuss preventive care.

Regardless of frequency, there are a number of tangible health benefits among patients who access routine preventive counseling and services in a periodic health check-up, particularly when done with an identified, primary clinician. Studies have shown that patients who are connected to a specific clinician have higher rates of preventive services received Patients with more visits to their primary care providers are more likely to undergo screening for colorectal and breast cancer, have lower incidence and mortality of colorectal and breast cancer, and have lower overall mortality. Periodic visits may have other non-quantifiable benefits, such as developing the patient-clinician relationship, relieving patient “worry,” and educating patients about how to access the health care system.

It is for this reason that we at Santa Monica Primary Care continue to anchor patient wellness discussions with an annual examination. It creates a logical starting point as well as a recurring mile marker wherein one’s overall wellness is prioritized.  The USPTF has an excellent website which highlights the specific preventive services recommended by age, gender, body mass index, smoking status among other characteristics.

Link: https://www.uspreventiveservicestaskforce.org/webview/#!/

Generally a periodic health maintenance examination will cover the following broad topics (and these are broken out on our website for more details):

  1. Cardiovascular Disease Risk Assessment (includes assessment of modifiable risk factors: diet, smoking, hypertension, high cholesterol, obesity, physical activity, and diabetes mellitus)
  2. Cancer Prevention (includes: tobacco assessment and lung cancer, breast cancer, cervical cancer, ovarian cancer, colorectal cancer, prostate cancer, melanoma, multi-cancer early detection tests)
  3. Other Screenings (iron Deficiency, hypothyroidism, vitamin D deficiency)
  4. Immunization (Influenza, Tetanus/Diphtheria/Pertussis, HPV, Zoster/Shingles, Pneumococcal, Meningococcal, Hepatitis B, COVID-19)
  5. Sexually Transmitted Infections (gonorrhea, chlamydia, syphilis, Hepatitis B and C, HIV and HSV-1 and 2)
  6. Psychosocial Health Concerns (depression, anxiety, alcohol, drug use, intimate partner violence, firearms)
  7. Osteoporosis (all women over 65, post-menopausal women under 65 with risk factors and men with risk factors, clinical evidence of bone density loss or low trauma fracture)
  8. Vascular Disease (abdominal aortic aneurysm, carotid artery stenosis, peripheral vascular disease)