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How to Get the Most Out of Your Annual Physical
The Screen

by Ric Saguil, MD, FAAFP

I received notification from my high school that a childhood friend passed away. Tony happened to be my college roommate as well. As a physician, the event of passing-on always beckons the question, could this have been prevented. When I entered medical school the family doctor was the guy who knew each family member, was available if you walked over to his house and would take care of everything from diaper rash to dementia. In todays health care approach, primary care practices are thought to be a place where patients enter the insurance based medical maze to look for disease and stop it. My perspective of the current system is me entering a hamster wheel of healing, trying to give undivided attention to detail, package a plan for life change, then jump back on and see the next soul that I stumble upon. It is not uncommon that as I order tests, formulate a diagnosis, and give reassurance, to hear patients comment “this is the most time a doctor has spent listening to me”. It is nice to get validation I am doing the right thing to heal people but I'm not here for validation! I became a doctor because of an innate urge to serve humanity. The knowledge base imbibed over the 25 years of training has taught me the essential message within the symptoms of suffering is the answer to its resolution. Problem: how to extract the right information in your annual 15minute visit and reverse life threatening disease?

You can’t.

Medical insurance penalizes doctors for spending "excessive" time in a patient visit. Most patients only have catastrophic medical insurance coverage that covers annual physical exams and nothing more. (What policy holders don’t know is that your doctor is not allowed to address chronic issues during the yearly meet and greet) This glorified visit has been truncated to be a history review; a physical exam, cursory blood tests and the statement- “don’t smoke, get some sleep, eat right, lose weight and start exercising for the next 12 months”. Being on the receiving end of getting a mountain of information and only having 15 minutes to climb it, I have experienced some visits that are difficult and some that are effortless. Here is my formula to take advantage of a “wellness screen” (aka annual physical) where both patient and doctor walk away fully accomplished.

1- Expedite the transfer of information with a summary of symptoms (if you are suffering from something that is concerning to you). Write the diary in chronological form and keep it 1-2 pages large font. You will have to be poetic in descriptions but editorial in cutting out crap. Have pertinent test results available in chronological order (accordion folders are good) but don’t just hand this folder over (very overwhelming to the person that accepts the gift); when doc reviews your narrative, s/he will ask for certain tests if needed-highlight dates of testing so you can reference, pull out and show. Films are good to have but too bulky to manipulate during a physical exam and take too much off the clock to hold up and review. (Too many ingredients in the soup will obscure the essence and make it unpalatable.)

2- Stay focused on short answers to questions of inquiry. There is a tendency in chronic suffering to answer a question with “…this was preceded by…” or “…and then I developed…” leading to another problem. Western medicine docs think in single systems so jumping from digestive to respiratory to hormonal would lead to half-ass fact finding (ultimately leading to half-ass solutions)

3- Spouses (guys) usually need the partner present to make sure primary concerns are addressed in the end. This is especially true if the patient was prodded to get a checkup all the while thinking life was good. (Some don't realize how the depth of their problem effects the family.)

4- Have a list of prescription medicines, doses and times per day; supplements with ingredients and times per day and your average dietary intake per day all listed. If I can scan your "pills", I can tell you what interacts and where you don't have to spend alot of money. (As I tell my patients, if I can save you 50 bucks a month, use it to get a massage or go buy a healthy dinner!)

5- Keep up to date with medical problems suffered by relatives. This is a neon sign that helps docs figure what is in the family genetics or childhood surroundings that may lead to development of disease. (ie, if heart disease is in the family-doesnt matter if you are an athlete, we should work up your heart.....statisticians will say likelihood of heart attack is low but if you are the lucky guy/gal who is hiding a widowmaker, I have to console your family while 911 is rushing you to the hospital.

6- Research from reliable sources (Medscape, DrOz, DrWeil, WebMD) on hot topic items. Usually the buzz in social media will surround release of new information or new controlled trials. May involve a medicine you are taking or a symptom you are dealing with. It never hurt to ask for a specific test to find disease early but you and your provider have to be prepared on what to do with the results. Caution: just because your doctor writes an order doesn’t mean it will be paid for by insurance. The insurance pencil pusher will always tell my patients “as long as the doctor writes a diagnosis of maintenance/routine, it will be covered. Yeah right, I write it, then the lab says they can't run it with a "routine diagnosis code"; you get a $200.00 per test bill and there goes your life savings.

7- Ask to change into a gown before the doc enters the room so you can save time and encourage direct visualization/examination versus having to excuse yourself, change, reenter, get on the table ……When a physician is running 30minutes behind, 3 minutes of idol waiting in the hallway is stressful while other patients are peeking out of the room wondering "when am I going to be seen?". During a physical exam, if you arent ready to show, I am skipping over it and just handling big ticket items-this may miss a skin lesion or tell tale signs of thyroid deficiency......

8- Expect to come into the office for follow up discussion of results and further planning. The old thinking of no news is good news just actually means doc never got your results and didn’t call. Also know who the contact person is in the office to communicate with the doc. Modern medicine doesn’t allow time for docs to call back and answer questions personally, there is usually one person s/he trusts to relay messages and plan. (Don’t take it personally, providers are usually in and out of the hospital, office or surgery and if you insist on a personal call back, in most cases it will induce resistance or you will be placed in a long cue that gets buried in a pile of unanswered messages.)

This sounds like you have to do a lot of work to get a routine annual physical…..and you do! Unless you are not the average American with prehypertension, prediabetes, slightly overweight with elevated cholesterol, working 40-50hours weekly, and not meditating on a regular basis, you have to be your own advocate for staying healthy and living until 90-disease free and happy. If you have an Integrative Medicine physician, or an old school doc who knows how to listen-grab hold and do what you can to see them annually (no matter what the statistics say about maintenance physicals) Some docs that offer membership for a retainer fee (like a lawyer) essentially take care of steps 1-7 so you don’t have to worry about it-this is good if you can afford it. Bottom line is that if your gut tells you it's time to make a change, you are probably carrying a few medical risks. In the case of my friend Tony, even with Pancreatic Cancer that has a poor prognosis, I am sure a few extra years would have been appreciated by his kids. I believe any properly trained doctor can help you template a change to avoid catastrophic life ending disease , but it starts with the precious face to face time of a wellness screen.