Date: Fri, 16 Jun 2000 14:00:08 +1200

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From: USSW

Date: Tuesday, 3 February 1998 06:06

Subject: What Makes a Proper Physical Exam?

In from the Silicone Angel.

1:07 PM (ET) 1/28

What Makes a Proper Physical Exam?

NEW YORK (AP) -- A proper physical examination doesn't simply depend upon a doctor giving a comprehensive battery of tests. It results from a good relationship between you and your doctor.

Of course, there are important tests to be made, which vary according to a patient's age, sex, lifestyle and the environmental risks to which he or she has been exposed. But a proper physical exam begins and ends with a physician getting to know you and tailoring his examination to who you are.

The first step is for a physician to take a complete medical history. A good history states what, if any, diseases have afflicted you or your family, including alcoholism, cancer, allergies, hypertension, diabetes and coronary heart disease.

A good medical history also includes a social history -- marital status, children, work, sexual orientation and screens for depression, drug abuse, cigarette smoking, and even violence in the home.

During the interview, the physician builds trust with the patient and determines diseases for which he or she may be at risk, as well as steps that can be taken to prevent them.

Your doctor should also investigate any environmental risks to which you may have been exposed. Exposure to toxic chemicals in the workplace, contact with atypical diseases from travel, repetitive tasks at work and a highly competitive work environment -- all produce health risks. They can lead to anything from toxic poisoning to carpal tunnel syndrome to depression and anxiety that result from chronic stress.

Beyond a thorough medical history, a physician further examines your health in ways that vary according to your age and sex. If you are between 20 and 40, a physician should check whether you have been immunized for measles, mumps, rubella, polio, varicella, diphtheria, tetanus and Hepatitis B.

Your doctor also should check your blood pressure and cholesterol level. If your cholesterol level is elevated, the physician should do a lipid profile to further determine your risk for heart disease. Finally, all patients should receive a skin test for tuberculosis.

Men between 20 and 40 may need testicular exams. Women between 20 and 40 need Pap tests every one to three years, depending on their sexual activity, and they should have a routine breast exam once they reach 35, or earlier if there is a family history of breast cancer, in which case mammography also might be necessary.

Sexually active women also should be screened for gonorrhea and chlamydia during their pelvic exams, and both men and women should be tested for the HIV antibodies if they have a history of high-risk sex or potential occupational exposures.

If you are between the ages of 40 and 65, the same tests apply. But your physician also needs to make sure your immunizations are up to date and should scan for glaucoma as well.

A digital examination is also recommended for this age group. The exam consists of a stool test for blood, which can be a sign of colon cancer.

Once 50, however, your rectal examination should not only include a stool test but a flexible sigmoidoscopy. This test, recommended every three to five years, checks for colon cancer by passing a tube through the rectum to check the lining of the sigmoid colon, a section of the large colon.

Men between 40 and 65, at some point, will need two tests for prostate cancer: a digital prostate exam as well as the PSA (prostate specific antigen) test. The American Cancer Society believes those tests are necessary once you reach 40, but the American College of Physicians recommends that physicians and patients discuss the merits and drawbacks of PSA testing.

If you are a woman above 40, you should, at minimum, receive annual breast exams and mammography every two years until you turn 50, at which time the mammography should be done annually. The American Cancer Society recommends that mammography should be an annual event for 40-year-old women.

Above the age of 65, all of the screening tests from before are important, but so are annual vaccinations against influenza and one against pneumonia every 10 years. Your doctor should also make sure you have been immunized against tetanus and diphtheria within the past 10 years. You should also see both an ophthalmologist and an audiologist to test your sight and hearing.

In short, there are a modest number of tests common to all medical exams. The best rule to remember is that a good examination fits the individual's history and health. For that reason, the more you can reveal to your doctor about your health and that of your family, the better your exam will be.

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Dr. Mitchell Charap is associate professor of clinical medicine at

New York University School of Medicine.