Dr. Jacqueline Gerhart: A Yearly Physical Might Not Be Needed
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I just got on Obamacare, and have a child – but we are healthy. Do we both need a "yearly physical?"
Dear Reader: Great question. A "yearly physical" is somewhat of a misnomer. It probably should be renamed a "preventive visit." The term "physical" implies that you will need a full "head-to-toe" exam. In reality, we may not need to do this every year.
The timing of a "physical" depends on your age, gender, health history, family history and the medications you take. While there are general guidelines based on an otherwise healthy patient who is not on medications, every patient – and every provider – is different, so please talk to your physician about what is right for you.
In my practice, for example, babies come in for a newborn check within the first few days of life. I then do a weight check at two weeks and well-child visits at 2, 4, 6, 9 and 12 months. Then I do a 15- and 18-month check, and yearly checks from ages 2 through 5. Between age 6 and 18 years, I either do yearly checks or every-other-year checks. Most kids need another Tdap vaccine just before entering sixth grade, and high schools often require a "sports physical" every two years – so I schedule "yearly physicals" based on those requirements as well.
After age 18, the frequency depends on whether you are on medications and if you are sexually active. For women, pap smears start at age 21 regardless of sexual activity, so I ask my female patients to schedule a "physical" when they turn 21. Guidelines differ on how often a woman needs a clinical breast exam. While the American Cancer Society recommends them at regular intervals starting as young as age 20, the United States Preventive Services Task Force states there "isn't enough evidence" to recommend for or against getting breast exams.
In my practice, I usually recommend breast exams and pap smears every three years between age 21 and 30 – and I discuss with patients the benefits and risks of routinely screening at this interval. There may be other reasons to see these patients more often – such as STD screening and medication management. This can be done at a "physical" or at a "medication management" appointment to go through medications and needed screening exams based on those medications.
New guidelines state that patients can do pap smears and HPV testing, starting at age 30, every five years instead of every three. I still, however, recommend that my patients have a "physical exam" every two years or so. In between these exams, I ask them to schedule "med check" appointments for refills, labs and other concerns as they arise.
Bottom line, in my practice, the term "yearly physical" isn't always accurate. If patients are not on medications and have no other risk factors or labs we are monitoring, I often will see them every other year – especially between age 15 and 30. Many women are uncomfortable without a yearly physical, and I continue to offer this option for women who would like more frequent monitoring.
As always, discuss frequency of exams with your doctor as he or she may feel you need a different preventive exam schedule.
In a future column, I will discuss frequency of physical exams for patients aged 40 and over.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 04/16/2014