When I moved to NC a couple of years ago I, of course, had to get new doctors etc. I ended up getting a PA who is about 40 years old and seems competent.

The issue is the physical is not as "thorough" as I had with my former primary doc for over 30 years. My height and weight is measured. I also have what I believe to be a fairly extensive blood work up done. Then there's the usual conversation on how things are going etc. while he listens to my heart and that's about it.

With my previous primary I had my prostate checked (fickle finger of fate), and was checked for possible hernia but not here. I was also given a kit to have my stool sampled and mailed in.

So my question, and hopefully one of our docs will chime in, is there a formal list of what a mid 60's male should have examined during an annual physical?
Thanks.

Re: Prostate and stool checks - I was told by my PCP that they were discontinued as they were ineffective. Absent symptoms, there was no advantage to doing them.

When I switched to the VA for my primary care, about the only thing that changed was bi-annual vs. annual visits and blood tests were more thorough.

Your annual physical sounds about typical. There have been several recent articles that question the value of annual physicals in the absence of symptoms. The chances of physical examination detecting something significant that was not evident in the lab work or revealed by patient report are pretty slim.

Lab results should indicate your PSA reading, which, although not perfect, is a better indicator of prostate cancer. The finger wave only checked for prostate enlargement.

^^^^

PSA is a lot worse than "not perfect". It is a diagnostic test being inappropriately used for screening of asymptomatic patients. Your chances of undergoing an unnecessary biopsy and treatment that results in side effects is approximately 50x that of being helped by a timely diagnosis.

quote:

Lab results should indicate your PSA reading, which, although not perfect, is a better indicator of prostate cancer. The finger wave only checked for prostate enlargement.

In addition to enlargement, the examiner feels for any indurations on the surface of the gland, a lack of smoothness… a very important finding. If an induration is determined and the earlier PSA level is elevated, a needle biopsy is required.

The PSA should be performed prior to the digital exam because stimulation of the prostate can cause a false indication of an elevated value.

quote:

Originally posted by MNSIG:
^^^^

PSA is a lot worse than "not perfect". It is a diagnostic test being inappropriately used for screening of asymptomatic patients. Your chances of undergoing an unnecessary biopsy and treatment that results in side effects is approximately 50x that of being helped by a timely diagnosis.

^^^^
This is correct… overdiagnosis was a huge issue!

quote:

Originally posted by MNSIG:
Your annual physical sounds about typical. There have been several recent articles that question the value of annual physicals in the absence of symptoms. The chances of physical examination detecting something significant that was not evident in the lab work or revealed by patient report are pretty slim.

That's spot on of what I was going to say. In fact, one school of thought is that the typical annual physical is a waste of time. Barring symptoms of one thing or the other.

My insurance pays for something called a "wellness" visit which is a more comprehensive annual. My lady doc is very engaging and it's as much a social visit as medicinal.

Now, if a patient tends to ignore symptoms (John Wayne's "a good soldier don't feel no pain"...) kind of thing, I suppose the annual could be good.

I don’t really get an annual physical, but end up every 2 years for various reasons. I went a month ago, blood work included.

Though it can run in the family, my triglycerides seemed to spike for no reason, 400+. They have previously been in the normal range. I didn’t fast beforehand, then they told me I should work on it, less carbs, higher protein diet.

Anyway, recent medical status.

quote:

Originally posted by sourdough44:
I don’t really get an annual physical, but end up every 2 years for various reasons. I went a month ago, blood work included.

Though it can run in the family, my triglycerides seemed to spike for no reason, 400+. They have previously been in the normal range. I didn’t fast beforehand, then they told me I should work on it, less carbs, higher protein diet.

Anyway, recent medical status.

If you were not fasting, depending on what you had to eat in the last few hours, makes the elevated triglyceride assay inaccurate, especially when showing elevated! the values for cholesterol, LDL and HDL are less effected. If those were within reference range of the lab, not to worry.

In my opinion (as a Quack) your cholesterol complex values are a result of genetics; while it is established that medications can reduce LDL (bad cholesterol) we are doomed by our parentage.

Thanks, that’s what I kinda thought, so no reason to go ‘red alert’.

I will agree, never a bad thing to eat healthy.

I was a little bummed, saw that IPA beer was on the naughty list. I don’t imbibe excessively, but the mood strikes at times.

I get the same treatment and it's been that way for more than ten years now.
The test I see as most valuable is the blood test screening as it could pick up trends for future harmful things. It also sets a baseline to compare later.
Otherwise, the question, how are you feeling is a harder one. I'm getting up there just past normal retirement age and each year I feel a bit worse than last year. Since I've never been here before, I don't know what's just normal aging and you have to complain about something specific to get much to happen.
Just for reassurance, I wish there was a good once over done every five years or so but the bean counters at insurers seem to rule.

As a male approaching 40 in the coming months, I am not at all upset to hear that medical science is trending away from a technique that would shatter my lifelong record of one-way traffic OUT my butthole. Hopefully my Dr. was copied on that memo!

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saw that IPA beer was on the naughty list

Interesting. Would you mind expanding on that. I'm curious.

It appears to me that the physical exam has evolved over the years to facilitate diagnoses of a variety of over-diagnosed incurable conditions (diabetes, hypertension, sleep apnea, etc.) that lead to life long symptomatic treatments with no hope of ever attaining a cure. It would be interesting to learn of a statistical study comparing the life expectancy and overall health of those having regular physicals in a doctor's office and those who avoid medical exams.

Logically, there must be an economic benefit to the diagnostician whether it is simply patient retention and revenue from "follow-ups," big pharma kickbacks (don't say this is not a reality, I have seen it happen), or some other factor.

This "treat but don't cure" philosophy is also evident in mainstream health/drug research, and availability of prescription medications.

Given the immense advances in science and technologies of the past hundred years, can it really be possible that medical science has fallen so far behind other disciplines when comparing advancements? I will concede that there has been a great deal of progress, the reduction of infant mortality alone has raised the average life expectancy by over 25 years for example, but maybe researchers are not looking at the right things, or economics are not encouraging their efforts in the most effective way.

quote:

Originally posted by 229DAK:

quote:

saw that IPA beer was on the naughty list

Interesting. Would you mind expanding on that. I'm curious.

The office said I should reduce carbs. Just saying, high octane IPA beer has a high level of carbs. I tried ‘sipping tequila’ the other day to mitigate. It worked rather well.

Re: PSA. Prostate cancers can be very slow growing or very aggressive. If your family history includes aggressive prostate cancers, PSA can be a life saver. PSA is not a measure of cancer itself, it measures something about cellular activity. Recent ejaculation, infection, physical exam, and probably other things can elevate PSA.

The value of PSA is the trend, considering your health history and any family history of prostate cancer.

The problem is when a man has never had a PSA test before, but starts having symptoms and now has a high PSA. This may trigger biopsies etc. out of caution. Whereas if he'd been having annual PSA tests there would be a trend to look at. Had it been creeping up towards 4? Had it been solidly low? Has it started trending up quickly the last 2 or 3 tests? What's the family history?

Regular PSA saved my father and his brother, knowing that their father died from an aggressive prostate cancer.

Absent additional factors, a single high PSA alone probably should lead to slow, conservative observation and perhaps a course of antibiotics. My opinion is some docs engage in too much defensive medicine, and/or patients panic about maybe cancer. And, I think insurers want to save money by getting rid of annual PSA screening.

Having an annual PSA provides a trend for the doc to consider along with everything else to come up with a smart plan for that patient.

quote:

It appears to me that the physical exam has evolved over the years to facilitate diagnoses of a variety of over-diagnosed incurable conditions (diabetes, hypertension, sleep apnea, etc.) that lead to life long symptomatic treatments with no hope of ever attaining a cure. It would be interesting to learn of a statistical study comparing the life expectancy and overall health of those having regular physicals in a doctor's office and those who avoid medical exams.

While I'm frustrated with the "lifelong treatment with no cure" thing, I'm pretty grateful that my family doc caught my Type 1 Diabetes during my annual physical three years ago. I was very close to causing irreversible damage to organs and eventual death because like a typical dude I was just sucking up the symptoms until my wife signed me up for an appointment. It sucks to be told that I have to take insulin for the rest of my life and can't eat good food anymore, but at least I still have a "rest of my life" to do it. I'd have been dead by now if I'd kept doing what I was doing.

I had my annual "wellness check" (that is what the practice calls it) this morning.

I am now of an age where a big part of the exam focuses on my mental capacity. Can I repeat a phrase spoken at the beginning of the exam at the end. Can I recite the months of the year backwards in correct order. Can I tell the time (approximately) without looking at my watch. Questions about falls, ability to handle my finances, and can I prepare a meal if necessary.

The physical exam is like described by most here. Blood work, blood pressure, weight, heart and lung listened to via stethoscope, ears examined. I was asked about any symptoms and given an opportunity to ask any questions. Took about 40 minutes.

Since I also have a cardiologist, pulmonologist and urologist my primary care doc makes sure I stay current with exams by them and receives their reports. So PSA test and prostate exam is by urologist.

Like most doctors in the area he is busy and if I am having a problem it can take awhile to see him. Fortunately he has a Physician's Assistant who is good and readily available. More importantly doc is reachable by email and responds after hours when necessary. Even better the practice operates a walk-in clinic that is open six days a week.

quote:

Originally posted by 92fstech:

quote:

It appears to me that the physical exam has evolved over the years to facilitate diagnoses of a variety of over-diagnosed incurable conditions (diabetes, hypertension, sleep apnea, etc.) that lead to life long symptomatic treatments with no hope of ever attaining a cure. It would be interesting to learn of a statistical study comparing the life expectancy and overall health of those having regular physicals in a doctor's office and those who avoid medical exams.

While I'm frustrated with the "lifelong treatment with no cure" thing, I'm pretty grateful that my family doc caught my Type 1 Diabetes during my annual physical three years ago. I was very close to causing irreversible damage to organs and eventual death because like a typical dude I was just sucking up the symptoms until my wife signed me up for an appointment. It sucks to be told that I have to take insulin for the rest of my life and can't eat good food anymore, but at least I still have a "rest of my life" to do it. I'd have been dead by now if I'd kept doing what I was doing.

Do you do the finger stick or do you use a CGM for testing your blood sugar level?