Doctor visits- how often do we need 'em?

August 22, 2005 8:09 PM

DoctorFilter: Do presumably healthy men in their late 20s get regular physicals?

My significant other is in what I assume to be decent health; we eat well and exercise, though our drinking is moderate to heavy. I say "assume" because he hasn't been to the doctor for a check up in almost 10 years, and I keep bugging him to just go and make sure things are working right. As a woman on birth control, I'm used to the annual physical, but I have no idea how frequently men really should be getting check ups. It seems like it would be a really good idea to get one before an entire decade of your life goes by.

Late 20-ish men of Metafilter, how often do you get physicals (especially if there's no pressing health issue that makes you need think "hey, I need to see a doctor")? Is it something that I should continue to nag him about, or am I just being paranoid?

posted by anonymous to health & fitness (25 comments total)

Men should get physicals yearly. You should force him to go. It's possible that colon, testicular and prostate cancer could go undetected and be deadly (it's unlikely at that age, but possible). It's also important to monitor things like cholesterol, which could be high due to heredity. There are also a variety of liver problems that could be made worse by the drinking.

Get him checked up!
posted by null terminated at 8:21 PM on August 22, 2005

Men should get physicals yearly for all the reasons null terminated states. As a woman who goes annually, it was definitely a big struggle to get my presumably healthy SO to go. Having the check-up be free under our health insurance, and with the doc I was already going to [so already checked out in some way] were the two data points that selaed the deal.
posted by jessamyn at 8:26 PM on August 22, 2005

Some entity - possibly the American College of Physicians - recommends a number of things for every person around age 30, of which one is a thyroid test and another is a physical exam.

Quit drinking so much.
posted by ikkyu2 at 8:35 PM on August 22, 2005

I'm out of date. Routine thyroid screening in adults is class I, not enough data to definitively state whether it's effective or not.

However, browsing this resource makes me suspect that there's probably something for a doc to do to improve the health of anyone who walked into her clinic.
posted by ikkyu2 at 8:53 PM on August 22, 2005

Yes, yes, he should go. Realistically, he probably won't. I pulled out my very best reasoning point with my SO which is that if you DO start having some funny symptoms, at least you will have a doctor with whom you have a history. He agreed that this was sound logic and a good idea. He'll still not bother to go to the doctor.

On the up side, don't make yourself crazy worrying. Late 20s with no symptoms is a bit young to worry about screening for anything besides cholesterol, unless he has a very significant family history.

Perhaps you can try compromising that at some particular age (30, 31, whatever) he'll indulge you and get checked out, and that in the meanwhile he is not to play it cool if he has any medical questions, but should scurry his ass to the doc without reluctance.

Or, in direct response to your question, my opinion is that you shouldn't nag him about it, but you're not being paranoid, either.

WTF with the random moral judgement interjection?
posted by desuetude at 8:57 PM on August 22, 2005

The real value of a check-up at this age isn't so clear. The idea of a "complete physical", from a cost-benefit perspective, is pointless. A directed, age-specific evaluation and risk-analysis has plenty of merit, though. For example, with this case, several issues would be germane:

Family history : alcoholism, depression/anxiety, and all the other usual issues -hypertension, diabetes, heart disease, have tremendous prognostic value.

Skin exam: Being undressed in front of a doctor once a year for a full skin exam - melanomas are prone to arise on the feet, buttocks, genitals.

Blood pressure: I see elevations at younger and younger ages, esp. if someone consumes more than an ounce or two of alcohol a day. Elevated BP, even mild, has huge long term consequences, so the sooner one finds out whether they are prone to it or not the better.

Ironically, listening to the heart, lungs, routine labs, are generally worthless from a pragmatic aspect. But patients value it and it probably furthers the doctor-patient relationship. That said, if a twenty-something came in because of a hectoring partner, and I knew they were drinking, odds are they would have normal liver chemistries and would get a false sense of confidence, much like the smoker with a 'normal' chest xray.

So annual physicals in young men who aren't at high risk for health issues, and who can learn to check their testicles and skin, are probably unnecessary. That said, I've never felt like they weren't worth the time, as I've always been able to find things to talk to a patient about, and everyone - everyone - has thoughts and concerns they usually find ways to bring up in a visit.
posted by docpops at 9:19 PM on August 22, 2005

I don't know about late 20s, but last time I went to my doctor for a "checkup", he wanted to know what was wrong with me. He didn't exactly look at me like I had ten heads, but I got the sense that most men in their early to mid 20s don't go in for checkups. I also got the sense I need a new doctor. But most men (even with a history or cancer) don't need to get regular checks until their mid 30s, as long as they check themselves (I monitor my blood pressure, as well as any signs of cancer). It wouldn't be a bad idea, though. You're paying for health insurance for a reason!
posted by Eideteker at 9:25 PM on August 22, 2005

I agree with the cost-benefit. If you're still with him, make him go on his 30th birthday. That way, when he checks out ok, he can still feel good about "still being young."

Moderate to heavy drinking; heh, I guess the definition of "moderate" or "heavy" differs depending on who you ask. Supposedly 5 drinks in a given day = godawful problem drinking to some people (snicker). As long as it doesn't interfere with work/school (for either of you) and it's not like you can't go a day or a few without getting drunk I wouldn't worry about it.

Besides, testicular and breast exams can be done at home, with each other.

I'd only recommend an annual checkup before age 30 is if there's a family history (of anything), obesity, or if some strange symptoms crop up (bloody stool, really dark urine, chest pains, strange lumps [anywhere], wierd skin changes, &c).
posted by PurplePorpoise at 9:38 PM on August 22, 2005

WTF with the random moral judgement interjection?

Alcohol is a toxin that damages every cell in your body. To avoid this damage, quit drinking so much.

I've been in this doctor game long enough to know that when someone gives the above story - "I'm in good health except I drink heavily" - the usual recommended intervention that's going to improve health is "Quit drinking so much."

I can't help it if you want to associate alcohol or cell damage with morality, as opposed to mortality - but leave me out of it.
posted by ikkyu2 at 10:08 PM on August 22, 2005

Speaking as a mid to late 20's man, I don't get physicals. And as far as I know, my friends don't either. Get off his back.
posted by spork at 10:50 PM on August 22, 2005

Yes, a physical is worth the time once a year.

Docpops, You're a doctor? What did you mean by, "Ironically, listening to the heart, lungs, routine labs are generally worthless , from a pragmatic aspect." Routine labs are generally worthless? How will early problems with liver or kidney dysfunction be found? Diabetes? Metabolic disorders? Anemia? How would you screen possible early problems with the thyroid? Adrenal gland? Pituitary gland? Clues to autoimmune disorders? Lab tests to discover these and other problems, and find them early, are far from "worthless."

As for listening to the hearts and lungs - how, for example, are you going to catch a defective heart valve or murmur by not listening to the heart?

I also have a problem with the comment about the liver and alcohol. What the patient may - or may not - read into positive lab results is not the responsibility of the physician. They should have the facts - and in the cited case, complete with warnings that the lack of liver dysfunction in the chemistry is not a green light for heavy alcohol use.

I'm all for the office physical - hearts, lungs, with routine lab tests.
-
posted by Independent Scholarship at 10:54 PM on August 22, 2005

I got my 30 year checkup a few weeks ago. Hadn't been to the doc in quite a while... just seemed like a good idea to check in and make sure everything was functioning properly.

... And it is.

Now we've got a complete set of lab results and whatnot available as a kind of baseline, to compare against as time marches inevitably on.
posted by ph00dz at 5:01 AM on August 23, 2005

As a late 20's male, I just had my first physical in over 10 years (at the insistence of my SO) and, thankfully, everything turned out just as I expected. Nothing wrong at all. Eideteker is correct, my physical was really nothing more than blood pressure, a few stethoscope-related tests (heart, lungs I would presume) and some blood tests. It really was not as bad as I thought it would be, so you might want to try using that angle.

Also, my doctor said I did not have to have another physical until I was thirty. Then she recommended that I return every year.
posted by purephase at 5:38 AM on August 23, 2005

My boyfriend goes for a complete physical every year. It's half an hour out of his day. He always checks out okay, and it's also a chance to ask about that mole on his back, or the vitamins he's taking or whatever little ailment or question might have been bothering him. I find the idea that men in their 20s "don't get physicals" a little bizarre to be honest, a bit "real men don't eat quiche".
posted by jamesonandwater at 6:03 AM on August 23, 2005

You're asking two separate questions: Do men in their 20s go for physicals on a regular basis? and, Should men in their 20s go for physicals on a regular basis?

Should they? Yes, probably, for all of the reasons mentioned above. (Or, if for no other reason than because he's a moderate/heavy drinker, and he should get his system checked out to make sure he can physically sustain that habit, if he has no desire to change it.)

Do they? No. I'm in my mid-20s, and short of an ER visit in 2001 for a stitches, I haven't seen a doctor since 1999 (for a signature!) and 1996ish for a checkup. All of my friends are in similar situations.
posted by NotMyselfRightNow at 6:27 AM on August 23, 2005

I'm 24, I had a physical about a year ago. I'm in good health but have borderline high cholesterol. My doctor said I should come in for physicals about once every two years at this stage in my life. I'm going to get one yearly though. If I get my car checked every 3k miles the least I can do is get myself looked at once a year, right?
posted by sciurus at 6:38 AM on August 23, 2005

Independent Scholarship:

If you come back and read this, let me clarify:

In fifteen years, I have not made a clinically significant discovery of pathology in an asymptomatic person between the ages of fifteen and forty by routine auscultation of the heart and lungs, and the data clearly shows that. I still do it, and will always do it. The point is that what patients perceive as the value of a physical, and what physicians see as the important elements, are very different. And my comments about liver testing and drinking still stand, based on the same years of experience. It follows that if an intelligent person is willfully performing an injurious act, i.e. drinking an amount of alcohol that by physiologic standards is excessive, then they have created an adequate defense mechanism to ward off thoughts of change. People need to be told emphatically, and often it still isn't enough, that normal labs do not rule out injury, just as a normal EKG is not useful for ruling out heart disease in someone who has had chest pain, just as a 'normal' chest xray is worthless at quantifying lung injury from smoking.

Again, a physical at this age is likely to be of the most value simply due to the time a patient spends in the office becoming comfortable with the basic notion of an exam, a health history, etc. so that they are more likely to return in the future when it becomes more critical. As for screening for early problems with the adrenals, pituitary, and autoimmune issues, I'm not sure where even to begin. Patients likely will be chagrined to see $300+ dollars of 'screening' tests on their bill that their HMO doesn't cover, for a start. Tests done in a vacuum, i.e. with no pre-test clinical suspicion, are a detriment to good care and because of their lack of specificity lead to further tests and needless anxiety.

Checking lipid levels, and a fasting blood sugar are critical, however.
posted by docpops at 7:28 AM on August 23, 2005

I'm thirty and I had my first complete (yes, complete) physical a few months ago. Nothing wrong with me, however I do drink alcohol, typically 1 to 3 a day.

Doc said, "quit drinking so much". He said 1 a day of wine or dark beer was completely acceptable, with the occaisional 2-3 at social gatherings.
posted by lyam at 7:35 AM on August 23, 2005

My doc recommended biannual checkups until my late 30's, which is now, and then switch to annual. Assuming there are no other problems of course.
posted by beowulf573 at 7:57 AM on August 23, 2005

As another mid-20s guy, I'm going to have to say I'm really bad at scheduling physicals. To be honest, I hadn't gone to a doctor for probably five years until a recent sinus infection. Because of that lapse in time, I didn't go for several weeks -- by that point, it was nasty enough that it took me two rounds of antibiotics to shake it.

If you have health insurance, it's a minimal cost, takes only a half hour to hour of your day, and any time there's nothing wrong with you? That's a success. I think for some guys, going to the doctor is like admitting that you may have weaknesses. Get over it, everyone bleeds. If you're lucky, you may stop it before it happens. How many guys trust their cars to work perfectly? I know the oil in my car is supposed to last a few months or a certain number of miles, but that doesn't mean I don't check it occasionally.
posted by mikeh at 8:15 AM on August 23, 2005

A lot of these responses are along the lines of "my doctor says I don't need to come back for two years" or "i got checked up and I had no problems". That's all well and good, but they only way you knew you were okay was to get checked up.

To expand upon sciurus' oil change example, it would not be appropriate to respond to the question "should i get my oil changed every 3000 miles" with "I didn't, and my car still works".
posted by null terminated at 8:23 AM on August 23, 2005

I think that a first checkup is important as a baseline test.

then, all future checkups are measured for deviation from the baseline.

I would suggest that he go for his physical, and then be happy that he returns every 2 years or so.
posted by seawallrunner at 8:24 AM on August 23, 2005

I scheduled a physical at the local gigantic medical megaplex last year (at 27) and they looked at me like I was fucking nuts. I figured that if my wife got a yearly exam I might as well get one too, no prodding even. They sent in an intern who did next to nothing, asked a few questions, and then just sort of drifted away.

I plan on trying again when I'm 30, but given the weird looks from my last attempt and the fact that I'm nothing more than a number I doubt that it'd do much good...
posted by togdon at 8:27 AM on August 23, 2005

I'm 30 years old. Two weeks ago I got my first physical since I was 16. I had some concerns, though, about potential pathologies, that my doctor kindly put to rest. I'm not sure I would've gone two weeks ago without these concerns (which had been concerns of mine for 10+ years.)
posted by u2604ab at 10:25 AM on August 23, 2005

In fifteen years, I have not made a clinically significant discovery of pathology in an asymptomatic person between the ages of fifteen and forty by routine auscultation of the heart and lungs, and the data clearly shows that. I still do it, and will always do it.

Ditto, although I only have about 9 years to report. I once once diagnosed bilateral carotid stenosis using my stethoscope in a 79-year-old, though.

And less than an hour ago I discovered an unsuspected right bundle branch block in a 29 year old who was hooked up to EEG telemetry, by means of the single EKG electrode we routinely put on to disambiguate the source of cardiac-voltage 'spikes' seen in the head electrodes.

How will early problems with liver or kidney dysfunction be found? Diabetes? Metabolic disorders? Anemia? How would you screen possible early problems with the thyroid? Adrenal gland? Pituitary gland? Clues to autoimmune disorders? Lab tests to discover these and other problems, and find them early, are far from "worthless."

They're far from routine, too, with the possible exception of the test that detects anemia. Know what you're talking about before you start typing. Routine tests will routinely miss all of the above.

What's worthless is spending billions upon billions of dollars on non-indicated tests in healthy, symptom-free people. Furthermore, because the normal ranges are usually 95-percentile ranges, 1 in 20 of all tests performed on healthy people will be read out as abnormal, requiring yet more costly, non-indicated, and possibly dangerous/invasive "confirmatory" tests, which will not confirm but instead do the opposite.

If you're going to slag off on doctors, slag off on them for subjecting people to dangerous, unnecessary tests, not the opposite.
posted by ikkyu2 at 1:00 PM on August 23, 2005