General Medical Checkup Check List, When, and How Often

People make appointments to see their doctor for many different reasons.

Some people only go to the doctor when they are sick or are experiencing a new problem or concern, and are looking for a specific diagnosis or treatment.

Some people see their doctor at more regular intervals for ongoing follow-up of a chronic problem or disease.

For many people, however; the frequency of office visits for a regular health maintenance checkup is not clear.

The requirements are different for

• annual medical physicals,
• prescription drug follow-ups,
• prenatal, childhood checkups, and
• well-woman examinations.

Some people expect to have a yearly checkup, and others feel that a checkup once every two to three years is sufficient.

In the past, most medical groups advocated an annual health exam. However, more recently, the American Medical Association and other similar groups have moved away from the yearly exam. They now suggest that medical checkups be referred to as Periodic Health Assessments or Examinations and that they be performed every five years (for adults over 18) until age 40 and every one to three years thereafter. The requirements are for more frequent evaluations for those taking prescription medications.

Most people younger than 40 years of age are generally free from diseases that could be diagnosed by physical examination alone. In this age group, health problems usually show specific signs or symptoms that would prompt you to seek medical attention. Also, a lot of the testing that was done routinely in the past has not been found to be cost effective and, in some cases, causes unnecessary additional testing and anxiety.

• Purpose of the periodic health examination
  • As primary prevention
  • To identify risk factors for common chronic diseases
  • To detect disease that has no apparent symptoms (secondary prevention)
  • As a way for the doctor to counsel people to promote healthy behavior
  • To update clinical data since last checkup
  • To enhance the relationship between you and your doctor

A panel of doctors under the direction of the U.S. Department of Health and Human Services studies the effectiveness of screening tests for early detection and prevention of disease. This group is called the U.S. Preventive Services Task Force.

The main goal of prevention and health promotion is to reduce the burden of suffering for the major preventable diseases. This task force has identified the 70 leading causes of death and disability in the United States and has ranked them by severity, prevalence, incidence, and potential for improvement. The task force has made recommendations on methods of avoiding these diseases through specific interventions.

• There are three levels of preventive care: All three of these levels of preventive care are important components of disease prevention and health maintenance.
  • Primary prevention includes interventions that can completely prevent the disease in people at risk. One example is immunizations against certain vaccine-preventable diseases such as measles and tetanus.
  • Secondary prevention identifies established risk factors for disease. Checking blood pressure, cholesterol, and performing Pap tests for cervical cancer screening are examples in which identifying abnormal results can lead to effective interventions that may prevent serious disease from developing.
  • Tertiary prevention is a process for optimizing health once a disease has been diagnosed. An example is a management plan to prevent a person from having another heart attack once they already have established heart disease.
• Preventive interventions your doctor may use at your checkup are:
  • Screening tests are useful in the early detection of disease. Some examples include the physical exam, blood pressure reading, Pap test, and laboratory tests.
  • Immunizations include shots such as a tetanus booster, flu shots, and other vaccinations.
  • Medication prescription may be as simple as suggesting that a person with heart disease risk factors take an aspirin daily.
  • Counseling for health promotion either before or during a health problem may decrease the burden of suffering or prevent the disease. Examples of counseling topics include smoking cessation, safe sex practices, and pre-pregnancy advice on folic acid supplements.

What can you expect at your checkup?

• Clinical history: Updating information on your chart or medical record is important. Some of the items you will likely be asked about include the following:
  • Dates and results of previous preventive procedures (such as prior immunizations, Pap tests, mammograms, cholesterol levels, and blood pressure readings)
  • A complete and updated family history of diseases: This will give your health care professional an idea about which diseases are common in your family.
  • Your past medical history, including a review of all medications you take and previous surgeries
  • Information about your workplace and leisure and living conditions at home
  • Your habits such as recreational drug use, alcohol use, smoking, exercise, sexual practices, and seat belt use
  • Information about your normal body functions such as eating, sleeping, urination, bowel function, vision, and hearing
• Physical examination and diagnostic tests
  • The number of physical examination maneuvers your doctor performs and tests that are ordered will vary depending on your gender, age, and information obtained from the clinical history.
  • The physical exam is most useful in identifying disease in people who already have symptoms, but it is often of little use as a screening test in people who have no complaints.
  • The U.S. Preventive Services Task Force has developed age-specific charts for periodic health screening for the general population, with special interventions for high-risk populations. See more detailed information in the next section.
• Procedures no longer done routinely: Unless there is a specific reason for these tests to be done, the U.S. Preventive Services Task Force does not advocate routine testing of the following:
  • Hemoglobin
  • Blood chemistries
  • Urinalysis
  • Vision and hearing testing up to 75 years of age
  • ECG: Heart tracing
  • Screening for ovarian cancer
  • Screening for prostate cancer

Preventive services for ages 19-39

• Schedule of visits
  • Males: Every five years
  • Females: Every three to five years
• Screening
  • A thorough individual risk assessment
  • Height and weight
  • Blood pressure
  • Clinical breast examination (every three years starting at age 20)
  • Blood cholesterol levels
  • Pap smear (at least every three years after three consecutive annual normal results)
  • In high-risk groups, sexually transmitted disease testing
• Counseling and education
  • Limit dietary fat, general nutrition advice
  • Folic acid supplementation in women of childbearing age
  • Tobacco cessation
  • Advance directives
  • Drinking and driving
  • Safety belts
  • Contraception and safe sexual practice
  • Physical activity
• Immunization
  • Tetanus-diphtheria booster every 10 years
  • Varicella vaccine (if you have a negative test and no history of chickenpox infection)
  • Rubella vaccine (if you have a negative test)
  • Hepatitis B vaccine (if not done previously)
  • Influenza vaccine (optional, depends on personal preference)
  • High-risk groups offered pneumococcal vaccine, influenza vaccine, and hepatitis A vaccine (Ask your doctor if you qualify for any of these.)

Preventive services for ages 40-64

• Schedule of visits
  • Males: Every five years
  • Females: Every three to five years
• Screening
  • Individual risk assessment
  • Height and weight
  • Clinical breast exam yearly
  • Blood cholesterol
  • Pap smear (up to every three years after three consecutive annual normal results)
  • Mammogram (optional 40-49, yearly 50-75)
  • Colon cancer screening
  • In high-risk groups, sexually transmitted disease testing and diabetes screening
• Counseling and education
  • Limit dietary fat, good nutrition advice
  • Tobacco cessation
  • Advance directives
  • Drinking and driving
  • Safety belts
  • Postmenopausal hormone replacement therapy
  • Physical activity
• Immunizations
  • Tetanus-diphtheria booster every 10 years
  • Influenza vaccine (optional)
  • In high-risk groups hepatitis A and B vaccines, pneumococcal vaccine, influenza vaccine, rubella vaccine, and Lyme disease vaccine may be recommended
• Preventive medications
  • Daily aspirin for people with risk factors for or established heart disease

Preventive services for ages 65 and over

• Schedule of visits
  • Every one to two years
• Screening
  • Individual risk assessment
  • Review of medications
  • Height and weight
  • Blood pressure
  • Clinical breast examination
  • Blood cholesterol
  • Colon cancer screening
  • Pap smear (may be performed at the mutual consent of the woman and doctor after age 65)
  • Annual mammogram until age 75
  • Vision testing after age 74
  • Hearing testing after age 74
• Counseling and education
  • Limit dietary fat, good nutrition advice
  • Drinking and driving
  • Safety belts
  • Postmenopausal hormone replacement therapy
  • Physical activity
• Immunization
  • Tetanus-diphtheria booster every 10 years
  • Annual influenza vaccine
  • Pneumococcal vaccine
  • In high-risk groups, hepatitis A and B vaccines
• Preventive medication
  • Daily aspirin in people with risk factors for or established heart disease

The recommendations of the task force are for healthy people. Those with specific diseases or who are at increased risk for certain health problems may be required to see their doctor more often and may undergo certain other tests. You and your doctor should mutually decide on a checkup plan that is suitable for your particular situation.