Notes

Is the Head-To-Toe Physical Exam Practically Worthless for Healthy Patients Who Are Asymptomatic?
As a health economist, I try to keep up to date with new trends in medical care insurance. cost of DOT exam have found is that consumers can now purchase short term health insurance policies that will purchase doctor visits if the individual is sick, however they will not purchase the typical "complete physical" connected with a short visit. Some primary care doctors won't see a new patient unless the doctor can bill insurance for $350 - $500 for a comprehensive visit. If you make an online search for "head-to-toe physical" and "outdated," you will see many web pages that provide arguments and evidence that the entire physical is indeed not essential but could be reassuring for some patients. In contrast, the blood tests are ten times more important than a complete physical for new patients.

We often hear the argument a good baseline physical exam with lab work is essential and will help engage the patients in their own care as well as identify those patients at risk for cardiovascular disease, diabetes, along with other problems. The patient centered medical home model is made on coordination of care, not sick care. For standard medical health insurance policies (those polices other than short term policies), at least one annual "physical exam" or wellness visit is covered 100% by insurance no cost to the consumer.

I am searching for a new primary care physician and will be seeing one at the end of the month. This appointment is for a new patient and will be coded for insurance as "wellness visit, physical exam" despite the fact that there will be little or no physical exam. Instead, Ethereal Paradox plan to use the time to tell the physician what blood tests I want on this visit to set up a baseline, and in the process of explaining why I'd like them, he will find out about my health background. I doubt you will have any moment remaining in the appointment for a good limited physical exam, but we shall see.

My cholesterol numbers aren't simply excellent, they're outstanding. The same holds true for my C-reactive protein (a way of measuring coronary attack risk) and homocysteine (a way of measuring stroke risk). I have not had a complete physical exam in over twenty years and also have not missed them one bit. I find it appalling that any physician would palpate my abdomen and then tell me I don't have any tenderness there, as if I did not know that. I am all and only preventive healthcare, but I buy into the U.S. Preventive Health Task Force that the entire physical exam is not shown to be cost effective at preventing disease. Blood testing, however, is crucial to monitoring general health and critical to formulating a technique to avoid diseases and medical ailments.

I have already been asking primary care docs for quite some time now should they have ever found an abnormality on physical exam in an asymptomatic patient that has been not picked up within standard screening (PAP smear, colonoscopy, lab testing, etc.) There have been minimal positive responses. (One doctor found an oral cancer). Standard screening could be done much more effectively and efficiently by non-physicians as part of a public health campaign: think of the Polio vaccination campaigns of the 1940s and 1950s.

Having said that, an appointment with the patient/client for health planning purposes -- identifying the most important thing to him/her and the impact of medical issues on those things which are important and then creating a mutually acceptable anticipate how exactly to achieve those goals -- is most likely invaluable, especially if health related conditions has no financial fascination with the choices which are made.

Yet we find an incredible lack of evidence to support "annual physicals exams" resulting in early detection of health problems. I invite the proverbial interested reader to go through the link at the bottom of this article to find the reference for the National Institute of Health's pubmed link linked to annual physicals.

In examining a population of junior high and senior high school student athletes who have been required to get "participation physicals" in order to play on sports teams, one study found of 1268 students, 5% were referred to specialists, but only 0.2% were disqualified from playing the sports activity. The author concludes that the majority of those disqualified would have been discovered by obtaining a detailed medical history alone. Another study of 763 student athletes found 3 positive referrals total. Factoring in the expense of all the health workers involved, each of these three findings came at a cost of $4563. Furthermore, a total of 16 medical problems were found during the 763 student physicals, BUT 15 of the 16 problems were, and could have been identified, from taking the patient's medical history alone.

How will you think most primary care physicians would react if a new patient went over his health background but declined greater than a cursory physical exam and only getting his desired blood tests? Would the typical primary care doctor simply note "patient declines complete exam" and move on, or would he/she badger the patient into getting a complete physical, because that what sort of doctor always handles new patients? One problem with health care is that patients are usually obsequious and belong to lockstep patterns of getting certain exams or tests even though they have little to no benefit on overall health.

I frequently hear from foreign-born and foreign-trained physicians that "within the US, doctors spend a lot of time on treating people after they get ill and not enough time of preventing the illness from occurring." But what does this mean in practical terms? (1) doctors ought to be ordering more blood tests to find out average sugar levels (HbA1C test) such that all patients know their HbA1C numbers and if they are inching towards diabetes. Other helpful blood tests would add a hormone panel for several middle-aged or older patients, and the doctors need to learn about optimal levels for these hormones, instead of ignorantly dismissing results that fall in the "normal average" range but could be sub-optimal. (2) doctors have to have staff who can answer patients' health questions, e.g., if the patient should begin taking magnesium, without placing an encumbrance on the doctor to answer each one of these questions. (3) patients should be given targets for HbA1C, HDL, total cholesterol/HDL ratio, cortisol, etc., to achieve through their very own proactive, informed collection of food choices.

I can't think about any blood test that would be ordered solely to create a patient aware. As a general rule, no physician can estimate the results from the blood test, e.g., no physician can estimate HDL cholesterol or total cholesterol just from talking to a patient and getting his medical history. When insurance companies stress preventive health, they always emphasize doctor exams over laboratory tests. But again, no doctor exam can reveal 3-month average glucose, or iron deficiency, or elevated liver enzymes. It appears like some insurance companies wish to accomplish preventive health on the cheap, sufficient reason for that attitude, they ought to not be surprised that the limited type of preventive care they support is close to worthless.

To state that the annual physical is worthless without reinforcing to the general public that some monitoring of health is necessary probably sends the incorrect message. After all, it is hard to argue that monitoring of hypertension, lipidemia and diabetes isn't worthwhile. FDA has generally indicated by its refusal to approve OTC versions of the maintenance medications that the public can't be trusted to monitor or manage these maladies.

I am all in favor of monitoring hypertension, lipidemia, and diabetes. In fact, where the Affordable Care Act recommends diabetes checking for people with hypertension, I would go further to state everyone should know her or his HbA1C number (3-month average of glycated hemoglobin). But why shouldn't those values be checked within an ordinary preventive health visit, with no need for a head-to-toe physical? None of the articles have said that tests are worthless; they have a tendency to question the worthiness of the "annual physical" for an asymptomatic healthy adult. Indeed some doctors have recognized this fact and present patients a more limited and directed physical exam. That approach seems more sensible compared to the "one size fits all" approach with head to toe exams.

The FDA has generally indicated that the general public cannot be trusted to monitor or manage these maladies. I strongly disagree with the FDA and question its motives in preventing cholesterol and hypertension medications from being accessible OTC. I hope in my lifetime that they do become available. An enlightened individual can use the Internet to understand about drugs that lower blood pressure, glucose, and lipids, combined with the drug's side effects. At-home blood circulation pressure devices are more effective in monitoring real-world blood circulation pressure than periodic visits to a doctor's office. An enlightened patient can precisely individualize dosing of anti-hypertensive medications to create their blood circulation pressure to optimal levels (below 115/75 mm Hg generally in most people).

For an expanded version of the article, please see http://www.michaelguth.com


Michael A. S. Guth, Ph.D., J.D., directs Health Economics & Outcomes Research (HEOR) at an increased risk Management Consulting, a contract research organization located in Oak Ridge, Tennessee, where he's got successfully managed the HEOR consulting business for days gone by ten years. He could be also a licensed attorney at law having an active practice greater than 200 clients and contains developed expertise on the Affordable Care Act and its own implementing regulations.
Dr. Guth's principal research focus has been avoiding the onset of age-related diseases known collectively because the metabolic syndrome. In the area of diabetes, he could be familiar with all of the drugs used to treat the disease and their potential drawbacks. Low thyroid hormones (T3 and T4) may represent just about the most unrecognized and under-treated factors behind prediabetes status affecting some 75 million Americans.
His current research comprises the perfect design of health care insurance and total health/wellness programs including preventive health strategies and employee health engagement and resiliency. Working as part of a global benefits team, he creates a built-in wellness-benefits strategy and executes programs targeted at changing mid- and high-risk behaviors. He positions wellness and disease-prevention within a larger strategy for medical cost containment, and contributes innovative ideas for achieving this desired result. He demonstrates thinking "outside the box" to rein in healthcare spending costs and reform patient usage of medical services.
A second section of current research is the usage of Clomiphene in men for hormone modulation to avoid cardiovascular disease along with other consequences of the metabolic syndrome. He is Principal Investigator of a clinical study that compares usage of Clomiphene with external sources of testosterone directed at men; the study includes safety, efficacy, cost, and value comparisons.

Homepage: https://writeablog.net/slipgoal95/neck-pain-management-of-neck-pain-without-medication-h3nq