The best way to make the most of your annual physical is to prepare for it. But knowing how to do that isn’t always obvious or intuitive. We asked Dr. Keri Peterson, a New York-based primary care physician, what patients should do before, during and after checkups. Here are tips to help you create a checklist.
How should a patient prepare for an annual physical exam?
First and foremost, I need to know everything about a patient’s medical history. Patients fill out a form that asks numerous questions about their medical history, family history, medications, allergies and surgeries that they have had.
What is pertinent to a patient’s medical history?
For me to get an accurate assessment of patients’ general health, I need to know the medical problems they’ve endured throughout their entire lifetime. This information gives me a sense of what to look out for in the future, how vigilant I need to be and what sorts of screening tests that I need to order.
Problems I need to know about include chronic medical issues like high cholesterol and diabetes. Patients have on occasion failed to mention medical problems that are already controlled on medications because these conditions are not currently an issue.
I also need to know about any significant medical issues patients have had in the past, such as skin cancer. I should know whether a cancerous mole was removed even if it’s no longer an active issue, so that it is on my radar.
How much family history do you need?
First, I need to know what medical problems a patient’s parents and grandparents have had, such as diabetes, high blood pressure and heart disease. Any family history that has a genetic component is going to influence my screening for potential disease. If the patient has a first-degree relative who had colon cancer at an early age, for example, I would want to order a colonoscopy before the recommended starting age. Even multiple second-degree relatives — aunts, uncles or grandparents — with cancer means there’s a higher probability of the patient having it.
Should patients bring their medications with them to the physical exam appointment?
Not necessarily, but they should make a list of what they take with names, dosages and whether they are prescribed or non-prescribed. Be sure to include vitamins and over-the-counter drugs as well. I like to also remind patients that this list should be in their wallets at all times, in case they wind up in the emergency room.
What other information do you need?
Allergies, including any side effects to medications, are important for me to know, so I don’t inadvertently prescribe them. I also need to know the type of reaction that they had, such as a rash or anaphylaxis.
I also want to know the patient’s vaccination history. Adult vaccines need to be maintained, updated or even delivered for the first time. Some patients don’t know what they’ve received in the past, so it’s ambiguous whether they will need it now. Patients in their 60s should receive pneumonia vaccines, but older patients often don’t remember whether they’ve received it or not. Tetanus shots should be given every 10 years, so if you’re cut by a nail in adulthood, we won’t know whether to administer another shot or not if the immunization records aren’t up to date.
What should a patient bring to the appointment?
It’s always helpful when the patient brings a list of questions for me. Write down your concerns and any symptoms you’re experiencing ahead of time. Otherwise you might be nervous and forget at the time of your visit.
Be sure to bring pen and paper to write down notes once the exam is over as well. During the appointment I will recommend screening exams and tests — mammograms, colonoscopies, eye exams and skin cancer screenings, among others — writing them down ensures that you won’t forget them.
Should the patient fast before the appointment?
For a physical, my staff advises patients to fast eight hours prior to the appointment for the bloodwork. Water and a cup of black coffee is fine if you usually drink it in the morning, though.
What about attire? Does it matter what the patient wears?
For annual physicals, patients will be gowned, so they shouldn’t wear constricting, hard-to-remove clothing.
What do you typically ask the patient in an appointment?
I ask all the questions on the intake form all over again so that I can learn about their history in more depth. I ask about surgeries, dental care — does the patient floss? Does he or she wear sunscreen? Has he or she had a skin cancer screening or ever been anemic? I’ll ask about eating disorders and other subjects the patient may be too embarrassed to bring up or to list on the intake form. I ask if the patient wants to be checked for any STDs.
I want to know about the patient’s lifestyle, exercise habits and how the patient’s diet is, including any dietary restrictions and whether he or she is vegetarian or vegan. This opens a door to a conversation about counseling if needed and lets me know whether to check for any vitamin deficiencies.
I also like to get to know my patients on a personal level, so I will ask them about their marital status, whether they have children and what they do for work.
What makes for an effective appointment?
The most effective appointments occur when patients have knowledge of their medical problems and the medications they take and are prepared with a list of things that they want to talk about.
When I’m getting a medical history, patients should be honest and forthcoming. Patients should never feel ashamed or embarrassed. If you have a sexually transmitted disease or had one in the past, or have or had depression, be candid. When asked about alcohol, be accurate in the number of glasses you drink in a week. If you smoke, be honest about how much you smoke per day.
What about an ineffective appointment?
It’s challenging if patients don’t know their medications or when they’ve had screening exams. It’s also challenging if they don’t know the details of their medical history.
What are some common questions patients ask you?
“Can you give me advice on how to lose weight?”
“Why am I so tired all of the time?”
“What are you checking for in the blood tests?”
How do you answer?
For weight loss, I have an extensive conversation assessing food intake meal by meal, and I make recommendations for dietary changes. I also assess exercise habits and give tips.
For fatigue, I do an extensive review of the patient’s medical history and associated symptoms, and then do an exam and order blood work to rule out possible causes.
For routine blood tests, I do a blood count, lipid panel, metabolic panel, diabetes screening and urinalysis. Depending on the patient’s age and sex, I will also order tests for PSA (prostate-specific antigen) to screen for prostate cancer and TSH (thyroid-stimulating hormone) to check for thyroid gland problems.