Keep in mind that even if you do have an abnormality detected on physical examination, it is often of little importance. For example, just as a freckle is technically not completely normal skin, minor abnormalities are often detected that have no bearing on your health. A lipoma (a benign tumor made up largely of fat) can cause a lump under the skin almost anywhere on the body; to be sure it’s not something serious (like cancer), it may be important to have it removed, but an examination that detects a lipoma is an example of how an abnormal examination does not always mean you have a disease.
Necessary Tests? Some health-care providers routinely recommend testing for people who are healthy at the time of their routine physical. In fact, very few tests have been shown to be helpful. For example, for a healthy woman over age 49, the AAFP recommends:
- Regular screening tests for colon cancer (such as stool tests for blood yearly and sigmoidoscopy, colonoscopy or barium enemas periodically)
- A Pap smear every one to three years (if she has ever been sexually active and has a cervix)
- Cholesterol measurement (with fasting lipid profile)
- Mammography every one to two years
- Visual testing (for the elderly)
That's it for people who report no health problems, symptoms or risk factors for specific diseases. Based on the evidence, other tests, such as EKGs, chest X-rays and blood tests are not routinely recommended for anyone without symptoms or risk factors for a particular illness.
Updating immunizations for the healthy adult is also important. Tetanus and diphtheria vaccinations are recommended routinely, with boosters every 10 years. Other vaccinations, including rubella, hepatitis B and influenza may be appropriate for people in certain risk groups.
Putting It All Together
Physicians integrate the information you provide from your symptoms, past health problems, physical examination and testing to detect disease or a risk of disease. If you feel well and have a normal exam, it's likely you are healthy. Unfortunately, many conditions can escape detection even with the best medical care. Sudden death may occur from heart disease or a burst aneurysm (among other reasons) despite a recent normal physical examination. It's a myth that a doctor can detect any health problem you have just by examining you.
Your doctor may ask you to come back yearly for a routine physical, but the real impact of such visits may be limited. It's best not to rely on routine doctors' visits to provide a guarantee of health. On the other hand, at your visit you may learn of risk factors for disease you did not know you had, or discover that what you thought was "just getting old" was really symptoms of arthritis or depression.
If you have symptoms or are worried about a particular health issue, see your physician. But for truly routine visits, understand that there are significant limitations for the detection of disease. Unfortunately, a normal examination does not mean you are absolutely healthy and, conversely, even if you have an abnormality on your examination or testing, many findings turn out to be unimportant.
For many, having a routine physical helps establish a relationship with their health-care providers, a process that can come in handy if you ever are sick. Establishing a relationship with a health-care provider may be among the best reasons to have a visit to your doctor, even when you are feeling well.
Last updated May 19, 2006
