Complete physical

By Joseph J Kozma

During my long and arduous training to become a practicing physician I never heard the expression of “Yearly physical”. Not in medical school, not during internship, not during residency training nor as part of a fellowship was that expression ever mentioned. Maybe I fell through the cracks, unlikely.

In the early fifties when I was in training, the emphasis was on diagnosis. The complaint (symptoms) came first, then examination, followed by treatment. Most of the medical care in the doctors’ offices of today follow the same pattern. The complaints, real or imagined, get the attention. But what if a complete physical is requested without complaints based on information obtained through advertisement, neighborly advice, worry, family history, etc.? Such a request may or may not be appropriate. After listening, the doctor can decide what the best course should be. It very likely will be symptom or circumstance guided and directed care. “Complete physical” will not be the answer. And if it is, what will it prove, solve, or in the worst case scenario, could it even makes things worse?

Look at this example: An elderly lady had been followed by her doctor for years. She had high blood pressure, controlled, feeling well. Once a year she had a more extensive examination that, in addition to physical examination, included laboratory tests and chest X-rays. In her mind and in her doctor’s she had as complete an examination as was reasonable, medically and financially. Her neighbor, a widow, was also having a similar experience in the same office weeks later. No problems so far in either case until the second lady developed abdominal pain. It happened at night and, being scared, she went to the Emergency Room. By the time she got there she had no pain. Nothing was done that night, but she was asked to return for an x-ray of the abdomen. The results showed a small cancer of the colon.

Cancers can go on for years without symptoms, undetected. Other times they develop fast and cause discomfort. This case caused the first lady to quit her doctor because a few months earlier he did not detect her neighbor’s cancer, which she very likely did not have at that time. She thought that the “complete physical” should have detected her neighbor’s cancer that, she thought, was overlooked. It is a great surprise if a routine test discovers an abnormality without history such as family, occupation, smoking, injuries, accidents, etc. After analyzing thousands of cases, many experts say that the so called “complete physical” is useless and unnecessary. Here is another example: One of my doctor friends told me that he gave a complete physical to a male patient in his 50s who was asymptomatic and checked out perfectly well. Everything was smiles. The patient left the office, collapsed on the sidewalk and died. That seems to prove that a “complete physical” is useless at times. And, it is right. What the general population needs and hopes for is early detection. It seems that, at the present time, that concept belongs to the public health category. During training, the would-be physician hears very little about that. He can if he wants to enter the field of public health.

It is not unusual to have a new patient telling you that he wants an MRI. His answer to “why?” is “because I want to know if I have anything wrong with me”. Of course that is a gross misinterpretation of the role of the MRI. That is not just his fault. The relentless advertising of the availability of medical “miracles” is at least partly to blame and in many instances causes severe confusion. Symptoms can be ignored because the examination such as a “complete physical”or laboratory tests did not show anything. Specific examinations designed to detect a particular problem are much more rewarding. Wouldn’t it be wonderful to have a test that would detect at 100 percent accuracy any hidden condition before it became symptomatic? That such a test will eventually be available is certain. It will be a complicated multiphasic test that will reach into the molecular structure of the individual and will be able predict a path that a person very likely will take if the circumstances remain the same. In the meantime, properly designed examinations are the way to go, not a “canned”, fit for all motions, erroneously called a “complete physical.”

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