Ray D. Strand
See book keywords and concepts |
 When physicians confront this situation, they usually recommend a complete physical exam with a comprehensive chemistry profile. On the next visit the physician will go over the patient's complaints again and review past, present, and family health histories. He will conduct another physical exam, and after the evaluation is complete the doctor will carefully review the laboratory data. Occasionally he discovers evidence of hypothyroidism, diabetes, anemia, or some other disease process that is causing these symptoms of fatigue. |
Gerald E. Markle and Frances B. McCrea
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 We carried home, in addition to complaining cats, a printout with our kittens' names, entitled, " Comprehensive physical exam."
"Just as annual physical checkups are recommended for people," we read with incredulity, "your pet should be brought in for a comprehensive physical exam each year, even if you aren't noticing any particular problems. Doing so helps us discover potential problems before they become more serious and aids us in keeping your pet healthy. |
| A 2002 editorial in the Annals journal identified trust as a first order goal of the physical exam, important enough in and of itself to justify the maintenance of the entire practice.
If careful study documents that patients who get annual examinations feel better, behave healthier, undergo more appropriate screening, and trust their physicians more than patients who do not have annual physical examinations, skeptics would need to reconsider the value of this yearly ritual.
Direct and intended worth is of course an important issue, but not the only issue. |
| Good medicine, in this logic, begins with routine screening of asymptomatic patients, and routine screening begins with a complete physical exam. Indeed, routine screening as part of the general physical examination has been "associated with dramatic reductions in morbidity and mortality." For example, mortality from strokes has decreased by more than 50% since 1972, a trend attributed in part to regular screening for blood pressure, which in turn led to the earlier detection and treatment of hypertension. |
Tori Hudson, N.D.
See book keywords and concepts |
 After a thorough medical history is taken, a physical exam and further laboratory testing and imaging may be requested not only to adequately diagnose the cause of the problem but also to determine if excessive blood loss has caused an anemic state.
The most worrisome situation is an acute bleeding episode. As stated earlier, bleeding that meets or exceeds saturation of a super tampon or heavy pad every hour for six to eight hours or more requires medical intervention. |
| Workup will include a medical history and may include a physical exam and further laboratory tests, pelvic imaging, and/or endometrial biopsy.
• Do not self-treat unless assured that the cause is DUB.
• Practitioners can often presume a diagnosis of DUB temporarily and recommend a further workup depending on response to the treatment.
PREVENTION ^
•
Reduce stress.
•
Avoid taking any form of estrogen without adequate progesterone or progestins.
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Engage in healthy lifestyle habits.
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Protect yourself against sexually transmitted diseases.
•
Use well-tolerated forms of contraception. |
| Not all of these considerations can be distinguished from the medical history, physical exam, and pelvic ultrasound. Surgery may be required to distinguish one condition from the other. Laparoscopy is the definitive method of excluding these other diagnoses from fibroids, even though laparoscopy is not typically done to diagnose fibroids. Only when there is great concern or lack of clarity about the diagnosis will the procedure be warranted. |
| When used to control bleeding, there is always a concern about the possible effect on the increase in growth of the fibroid, so fibroids need to be periodically evaluated by physical exam and/or pelvic ultrasound.
Agents such as leuprolide acetate (Lupron) have been used to temporarily control bleeding, correct anemia, and shrink tumors. This allows a large tumor to shrink to a more manageable size.
Lupron can be used to change the need for an abdominal hysterectomy to a vaginal or laparoscopic type, which shortens patient recovery. |
Ann M. Coulston and Carol J. Boushey
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 These children exhibit classic signs on physical exam of protein-calorie malnutrition: hypotonia, poor muscle bulk, peripheral edema, decreased subcutaneous fat stores, abdominal distention, and ascites in severe cases. Anemia is common. The anemia is usually microcytic, due to iron malabsorption. However, if the disease is long-standing, and small bowel involvement is severe, a macrocytic anemia can develop as a result of folate malabsorption. Radiographs can show osteopenia due to vitamin D and calcium malabsorption in prolonged, severe cases. |
Bill Sardi
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 Most breast tumors aren't detectable until they can be felt by physical exam and thus have been developing for 7-9 years. By then, a small number of tumor cells have likely escaped into the blood circulation. [Treatment of Breast Cancer, Clinical Symposia, 49: 4-32, 1997]
In 2002, it was reported that women with small breast tumors (2 centimeters, or about 1 inch in size), who elected to undergo subsequent chemotherapy due to spread of the tumor to lymph nodes, experienced about the same survival rate whether they had a total mastectomy (breast removal) or a lumpectomy. |
Michael T. Murray and Michael R. Lyon
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 We recommend that part of your annual physical exam include blood work (see page 41) to determine your CRP levels. The goal is to keep your CRP level below l.Omg/L. At this level, there is little silent inflammation occurring. If your CRP is between 1.0 and 3.0mg/L, that is a major caution. If your CRP is higher than 3.0mg/L, it is a serious red flag.
Dietary interventions alone have been shown to lower CRP levels. In particular, the Mediterranean diet can be quite effective in lowering CRP levels to normal. |
Tori Hudson, N.D.
See book keywords and concepts |
| OVERVIEW OF ALTERNATIVE TREATMENTS
A licensed alternative primary care practitioner such as a naturopathic physician must first make an accurate diagnosis as to the cause of the amenorrhea, utilizing a medical history, physical exam, and possible laboratory testing. Naturopathic physicians often see patients who are on extreme diets due to some other health concern; sometimes these diets are inappropriate for that individual and are the cause of the amenorrhea. Insufficient calories and insufficient dietary fat and cholesterol may be the culprit in some of these cases. |
Ray D. Strand
See book keywords and concepts |
| As I've mentioned physicians routinely perform pap smears, mammograms, blood work, and the physical exam primarily to see if any silent diseases already exist in their patients. What has been prevented?
Obviously the earlier these diseases are detected, the better it is for the patient. The point I want to stress here, however, is the minimal time and effort the physician or the health-care community actually gives to teaching patients how they can protect their health. |
Ann M. Coulston and Carol J. Boushey
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| With a more detailed history, physical exam, and laboratory investigations, these "asymptomatics" may have revealed evidence of trace mineral deficiencies, anemia, short stature, low bone density, and low serum fat-soluble vitamin levels. These patients may be identified through mass serologic screenings and are often first- and second-degree relatives of a patient with biopsy-diagnosed disease. A family history of gastrointestinal cancers or other autoimmune disorders is often elicited [51-54].
F. |
Ray D. Strand
See book keywords and concepts |
| He will conduct another physical exam, and after the evaluation is complete the doctor will carefully review the laboratory data. Occasionally he discovers evidence of hypothyroidism, diabetes, anemia, or some other disease process that is causing these symptoms of fatigue. But the overwhelming majority of the time, he finds nothing that sufficiently explains why the patient is feeling so tired and worn out.
At this point most physicians begin questioning the patient about possible signs of increased stress or symptoms of depression. |
Gerald E. Markle and Frances B. McCrea
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| The routine physical exam is comprised of myriad operations and screening procedures. When these were evaluated one by one, there was little unanimity about either their worth or their cost-effectiveness, and therefore their necessary inclusion in a routine exam. Of course, adverse outcomes are tolerable if the given test has a demonstrable effect on the reduction of mortality or morbidity. The Guide urged physicians to be more selective in the use of routine tests.
Perhaps physicians need to adopt a new focus for their practice. |
| Please remember," the printout concluded, "an annual physical exam is very important in allowing you to enjoy your pet's company for many years to come."
"Do not do unto others," Fran and I concluded, electing to save Jekyll and Heidi from the benefits of routine pet medicine. Hopefully, our decision was the correct one. At any rate, the cats meowed.
SCREENING
In addition to the "laying on of hands," primary care involves routine screening for a variety of diseases. |
| Some defend the physical exam, claiming that it, or any office visit, creates trust and thus leads to some good. If trust is a means to an end, the argument might hold. As an end to itself, increasing trust is untenable. This argument, which flies in the face of the medical model, is disingenuous.
As Fran said: "It's as if doctors are claiming that their overt treatment does no good, yet interaction with them does, even if they don't really understand how."
Such logic does not bode well for the future of scientific medicine.
What about routine screening? |
Bill Sardi
See book keywords and concepts |
| Barry is a 60-year-old executive whose insurance company wanted him to undergo a physical exam. His wife had been nagging him to go to the doctor for some time. A PSA (prostate specific antigen) test is required. His PSA is elevated. His PSA could be elevated for a variety of reasons aside from cancer. This sends Barry to the doctor for a follow-up exam and a gloved-rectal exam to estimate the size of his prostate gland. Enlarged it is, so a biopsy is suggested. |
Michael T. Murray and Michael R. Lyon
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| This exam should include health counseling and, depending on a person's age and sex, a complete physical exam and screening for diabetes, cancer, and heart disease. Laboratory assessment should include at the bare minimum a complete blood count (CBC); fasting blood glucose; and cholesterol levels (including LDL and HDL determination). We also recommend determining C-reactive protein (CRP) levels. The goal is keeping your CRP level below 1,0mg/L. (See chapter 7 for more information about C-reactive protein. |
Shannon Brownlee
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 In the days when doctors knew little more about a patient's condition than what they could glean from a physical exam, grand rounds served as a showcase for top clinicians. Onstage there was usually a patient, sitting in a chair or lying on a gurney, along with the senior physician and a doctor-in-training. Sometimes junior doctors picked a difficult case to see if they could stump the teaching clinician. Often they looked for patients with highly visible symptoms: a swollen joint, a distended belly, or a peculiar rash, anything that could easily be seen by the audience. |
Thomson Healthcare, Inc.
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 All women reported subjective improvement; on physical exam, a decrease in erythema and discharge were noted. Five of the women had significant colony counts on Candida albicans, which may have been secondary to prior treatment with antifungal agents (Hilton, 1995).
Consdpadon
Daily consumption of a beverage containing Lactobacillus cased Shirota (LcS) improved stool frequency and consistency and sense of well-being in patients with chronic constipation. |
Tori Hudson, N.D.
See book keywords and concepts |
| Diagnosis of PID starts with a combination of a good medical history and physical exam. The medical history should include a thorough sexual history. Symptoms include but are not limited to vaginal discharge, fever, chills, urinary symptoms, heavy menstrual bleeding, intermenstrual bleeding, and lower abdominal/pelvic pain. A
PREVENTION
KEY CONCEPTS
• Use barrier methods of contraception.
• Avoid illicit drugs and cigarettes, and limit alcohol.
• Treat previous STIs with appropriate therapy and be certain of resolution.
• Avoid douching. |
Bottom Line Health
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| If you're experiencing any of these symptoms, see your doctor, who will give you a physical exam and perhaps run some tests to rule out other possible conditions.
IBS can have a wide variety of causes, including muscle spasms in the colon as well as emotional stress.
Helpful: IBS treatment typically includes stress reduction, a shift to a high-fiber diet and possibly medication.
Important MS Drug Back on the Market
Steven K. Galson, MD, MPH, director, Center for Drug Evaluation and Research, US Food and Drug Administration. |
Mehmet C. Oz., M.D. and Michael F. Roizen, M.D.
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 Co through a physical exam. A doc will do a visual once-over to see if you have any medical abnormalities that can cause ED, like small testicles or a curved penis, as well as check blood-vessel pulses as an indication of vascular disease.
ž Have a lab test. He'll check important numbers like LDL and HDL cholesterol, triglycerides, glucose, TSH, DHEA, and testosterone to get a better picture of the underlying cause. |
Shannon Brownlee
See book keywords and concepts |
| Then the senior clinician would ask the patient a few questions and perform a physical exam before turning to the assembled white coats to discuss his diagnosis and what was known about the patient's condition.
Today, older physicians sometimes lament that grand rounds are no longer grand. All too often, the give-and-take between teacher and audience has given way to didactic lectures on some minute aspect of biomedical research, and PowerPoint has replaced actual cases involving real patients. But the Socratic spirit of grand rounds lives on in some hospital departments. |
Mehmet C. Oz., M.D. and Michael F. Roizen, M.D.
See book keywords and concepts |
| Echocardiogram and stress test: once at age fifty as a baseline.
6. Physical exam: yearly.
7. Bone mineral density: around menopause, and every five years after if normal.
8. Eye exam: every two years by an ophthalmologist.
9. Hearing exam: at age sixty-five and yearly in physical. 10. Oral exam: at least yearly by dentist.
Cancer Screening
1. Breast: breast self-exams monthly and by a doctor once or twice a year—once by general doc and once by your gynecologist. |
Joan Liebmann-Smith, Ph. D., and Jacqueline Nardi Egan
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 No wonder doctors always look into our eyes during a physical exam.
SIGN OF THE TIMES
^aPTjk The Eye of Horus is the inspiration for the "all-knowing eye" that today sits atop the pyramid on the back of the U.S. one-dollar bill. And the right eye (the Eye of Ra) is believed to be the origin of the Rx symbol still used today for medical prescriptions.
EYE SIGNS OTHERS CAN SEE
CIRCLES UNDER THE EYES
When we see people who have circles under their eyes, we're likely to assume the circles are due to lack of sleep—or possibly a hangover. But that's not always the case. |
Gary Null and Amy McDonald
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 Then I put all those pieces together with a general physical exam and see if the pattern suggests some of these other causes."
Patient education is key at this point. "Finally, when I get a picture and it's pretty obvious what is happening, I educate the patient sufficiently so that he or she can make an informed decision about going forward with the therapy," Dr. Stoll says. "I tell patients to make their decision very carefully, so that once having decided to go ahead they then are able to maintain that commitment. |
Benjamin H. Natelson, M.D.
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 A few years ago, a fifty-two-year-old pilot went for his annual physical exam and had his blood checked for prostate-specific antigen (PSA) levels. Although standard medical texts (and insurance companies) do not endorse using PSA as a screen for prostate cancer, it is well known that patients with prostate cancer often have elevated levels of PSA. So when the pilot's PSA rose from normal levels of 1.1 and 1.6 in prior years to 3.9, he became concerned. His doctor told him not to worry since the levels still were within normal limits, but the pilot said he wanted his prostate gland biopsied. |
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