What should a full physical include?

September 11, 2012 1:35 AM

What should a full physical include for an overweight, ex-smoker, no exercise 40-year-old man?

I'm about to turn 40 and am going to get a physical soon. I had one four years ago here in Seoul and it was weird: I had a colonoscopy, some weird chi testing,blood work, chest/abdomen ultrasounds, etc. I came out okay back then with the exception of A) being overweight, which I knew and B) possessing a fatty liver, which I didn't know and about whose implications I'm still unsure.

Some of that is wacky Korean stuff. I'm not getting any chi anything this time, and I'm 90% sure I don't need to do an endoscopy or colonoscopy (although the docs here all say I have to, as does my lovely and concerned wife, both of whom I'm trying to convince otherwise), but given the above, what SHOULD I be doing? What are the necessities, what should I not bother with, etc?

posted by Joseph Gurl to health & fitness (11 answers total)

Typically one gets a baseline colonoscopy around 50, with one every 5 years thereafter, unless there is a history of GI problems in your family or other risk factors, in which they might have started early. Other things that should be included are:

• Full office examination, including (sorry!) prostate
• Ultrasounds
• EKG
• Blood work, including lipids, Hemoglobin A1C, PSA and other stuff

Depending on the results, additional tests might be required. There may be additional stuff because of your previous smoking, but I've never smoked so I can't say. Unless you suspect your doctor is incompetent or trying to rack up charges (in which case you need a new doc), you should do what he or she asks: 40 is a key time, and knowing the new facts early can be very important.

Unless you drink a lot, the fatty liver is not a problem, except that you won't be able to donate blood. However, if you are quite a bit overweight, and have been so for a while, be prepared to hear soon that you have become Type II diabetic.
posted by ubiquity at 2:43 AM on September 11, 2012 [1 favorite]

Thanks, that's helpful. A few more possibly useful info points:

1. I'm not very overweight. 15-20 pounds. Was once in awesome shape, have become very sedentary. Spare tire, love handles, whatnot.

2. No family history of GI problems or anything. Gut of iron, in general.

3. I do drink, probably more than I should, but don't get drunk but once a month or so.
posted by Joseph Gurl at 2:49 AM on September 11, 2012

A skin and nail exam; or at least point out any moles, rashes, etc.

And being overweight, point out any joint pain or stiffness, edema, breathing or sleep difficulties.
posted by LadyBonita at 2:56 AM on September 11, 2012

A "physical" is a physical examination. Then whatever tests your doctor recommends based on your examination, age and risk factors, usually only a very few tests. Many people seem to assume that a "physical" includes much more than it actually does or should.

Do what your doctor recommends, he has access to all your previous results and can clinically examine you.
Don't follow advice from random internet people as to what you should do or not do, if you doubt your doctor's advice go get a second opinion.
posted by abx1-se at 5:34 AM on September 11, 2012

Why do you think you need a physical? In general, they are unnecessary. The only preventive services recommended by the U.S. Preventive Services Task Force for a man of your age are periodic blood pressure and cholesterol screenings. Unnecessary tests can lead to costly and harmful overtreatment. (It is probably a good idea to have a relationship with a primary care physician so you can get future care if needed, and that might require a physical, though I wouldn't want a doctor who did an unnecessarily indepth physical.)
posted by Mr.Know-it-some at 7:20 AM on September 11, 2012 [2 favorites]

Why do you think you need a physical? In general, they are unnecessary The only preventive services recommended by the U.S. Preventive Services Task Force for a man of your age are periodic blood pressure and cholesterol screenings. Unnecessary tests can lead to costly and harmful overtreatment.

Yes, this! Why, exactly, do you think you need one?
posted by Violet Hour at 2:34 PM on September 11, 2012

Well, 1) I'm in Korea, where standards and common practice differ from those of the US. 2) my wife is convinced I need one and she's quite persuasive and awesome so I'd rather find a happy medium 3) I'm about to turn 40 and am definitely in the worst shape of my life.

That said, lots of help in this thread: I had a consultation today and even the doc. agreed that their package physical is mostly full of unnecessary crap, so I'm going in on Friday for a very abbreviated physical: bloodwork, urine, chest x-ray, thyroid and abdomen ultrasounds, and a prostate check (probably unnecessary, but a battle I'm willing to lose in exchange for NO GODDAMN ENDOSCOPY WOOHOO!)

Cheers, Metafilter, you rule once again.
posted by Joseph Gurl at 9:11 PM on September 11, 2012

Except none of those things are useful or recommended if you are not having symptoms, and they can actually be harmful. I mean, I know it's your body and your money and you absolutely have the right to do whatever you want with both, but that's not a happy medium, it's insanity. You should be aware that you are hurting yourself to fulfill a cultural norm (which needs to be changed).
posted by Violet Hour at 9:31 PM on September 11, 2012

Do you have cites that some of those are harmful? My understanding is that these procedures are all safe, if not particularly necessary or effective.

(other than the x-ray, which I know can be harmful, but I was a smoker for a long time so I'm willing to risk that to get a sense of how the old lungs are holding up)
posted by Joseph Gurl at 3:17 AM on September 12, 2012

Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules: "...US [ultrasonography] should not be performed as a screening test."

Use and Misuse of Thyroid Ultrasound in the Initial Workup of Patients with Suspected Thyroid Problems Referred by Primary Care Physicians to an Endocrine Clinic:
"Inappropriate use of TUS may delay the evaluation and referral, overload diagnostic services, increase health care expenditure, and lead to harm through false positives that lead to further inappropriate action, the so-called 'cascade iatrogenesis.' ... Indeed, given the indolent course of most nonpalpable thyroid cancers and the relatively high rate of incidental, small thyroid cancers discovered by TUS-guided biopsies, harm seems more likely an outcome for such patients who will undergo unnecessary evaluations and suffer excess morbidity from anxiety and side effects of (overzealous) treatment."

For aortic aneurysm screening, see http://www.uspreventiveservicestaskforce.org/uspstf05/aaascr/aaars.htm. Looks like no clear evidence of harm from my quick scan, but in the unlikely case that there is evidence of a moderate AA, you should be cautious of any recommendations for surgery. "Two randomized trials showed no statistically significant mortality benefit from immediate surgical repair compared with frequent surveillance for intermediate-sized AAAs."

But as you note, a happy wife is a significant benefit.
posted by Mr.Know-it-some at 11:27 AM on September 12, 2012

Ok, so those things aren't harmful, but treatment following them can be. I'll be cognizant of that. Thanks.
posted by Joseph Gurl at 7:14 PM on September 12, 2012