A physical exam is an opportunity to focus on a health issue by taking a complete history and by examining you carefully. However, it is also a time to review preventive care and you are likely reading this because we have recommended that you book “a physical." In British Columbia, preventative visits are not covered by the Medical Services Plan but, by being efficient and preparing well, we can ensure that your preventative care is up to date when you come to see us for your physical. We put more time aside for these visits and it is often tempting to bring a list of your health concerns or symptoms to review, but often the very best way to use this time is to focus on ways in which we can promote well being, detect illness early and identify opportunities to improve health and longevity.
To tailor our recommendations for screening to you, we will need to review several elements of your medical history. Often, all of the information that we need can be found in your chart, but at times we will need to ask for more information from you about:
Your past medical history. We should ensure that we know about all of the major illnesses or conditions that you may have dealt with. We need to know about conditions like high blood pressure, diabetes, heart disease, cancers or conditions for which you have taken medication for long periods of time.
Your past surgical history. We should ensure that we know about all of the surgical procedures that you have undergone. Examples include tonsillectomy, removal of the appendix, Cesarean section, hysterectomy, etc.
Your medications. It is really helpful to bring all of the medications that you are currently taking, or an accurate list of these medications.
Your family history. It is particularly helpful for us to know some very specific details about your mother, father, siblings and children (your first degree relatives). We need to know whether any of your first degree relatives have had diabetes, heart disease before the age of 65 (this includes heart attacks, bypass surgery, cardiac stents and angioplasty) or strokes. We also want to know whether anyone has had colon cancer, breast cancer or ovarian cancer and Please let us know if any first degree relative has fractured a hip, had a substance use disorder, a mental health disorder. We may ask questions about other health conditions that members of your family have dealt with such as rheumatoid arthritis or inflammatory bowel disease.
Once we have collected this information we like to structure the core of a periodic health visit around seven domains of health. Each of these domains allows us to review personalized preventative strategies and to discuss whether testing is a good idea for you or not. This list is not exhaustive and some of these screening strategies may or may not apply to you. If you are interested in the science behind preventative care, you might want to look at: The Canadian Task Force on Preventive Health Care
Heart health. We will review your exercise habits, weight or BMI and diet and we will discuss your risks for heart disease taking into account your cholesterol levels, blood sugar, blood pressure, history of smoking and your family history. We will discuss how you might be able to reduce your risk of heart disease. It is very helpful to bring a home blood pressure log to your period health exam and to have any blood work that we have recommended done prior to your visit.
Breast health. We will review your risks for breast cancer and review the best way to detect disease early, including breast exams and mammography, for example. Healthlink BC offers a great resource for understanding the best use of mammography.
Colon health. Screening for colon polyps and colon cancer can be done with stool tests, sigmoidoscopy (a short scope to look at the lower 60 cm of your colon) or by undergoing colonoscopy. Screening can save lives by detecting non-cancerous polyps and cancer early and strategies are reviewed at Cancer BC. This testing usually starts at age 50, but can start earlier if you have a family member who has had colon cancer early in life, or if you have disease of the colon that increases your risk of colon cancer.
Pelvic health. Screening for diseases of the pelvis, including infections, precancerous conditions and cancers can be done at the time of a preventative care visit. For example, Pap tests can find abnormal cells in the cervix before they become cancer. Women age 25-69 should be screened every 3 years. Cancer BC has a nice review of this topic here.
Bone health. We hope to review ways to keep your bones healthy and strong at the time of your visit and it is important to identify risks for early thinning of the bones. Screening for osteoporosis, or thinning of the bones, using bone densitometry generally starts at age 65, although it may be appropriate to start earlier for some women. We should discuss your intake of calcium and vitamin D and review your exercise habits. Information about screening for osteoporosis can be found at Healthlink BC.
Mental health. Discussing mental health issues can be challenging for patients and a preventive exam is a great time to review coping, stress, substance use, and symptoms of depression and anxiety. It is important to know that your family doctor is interested in your mental health and has training to support you if your mental health is at risk.
Immunizations. There are multiple immunizations that we might review, depending on your age and health conditions. We may discuss or recommend tetanus, influenza, shingles and pneumonia vaccines. A good review of adult vaccines can be found at Immunize BC.
