8 steps to smarter health checkups

In this country, we do a much better job of treating illnesses than preventing them. We treat ourselves the way we treat our cars – waiting until they make funny noises before bringing them in, rather than scheduling routine maintenance.

But the ideal time to address certain illnesses is when the risk factors, rather than the symptoms, present themselves. Brooke Edwards, M.D., a professor of medicine at the Mayo Medical School in Rochester, Minnesota, explains, "The time to identify someone who is at risk for heart disease isn’t when he’s having chest pains. It’s 20 years earlier when his cholesterol was too high."

Disease prevention is one reason routine physicals are important. But there’s another: For common treatable diseases – including the most common types of cancer, such as prostate and breast – the earlier the disease is diagnosed, the better the odds that it can be treated.

The bottom line is that you are your own best health advocate, and in this era when changing health insurance and medical coverage, as well as increased mobility, force frequent physician changes, it’s up to you to keep track of which tests you’ve had, which ones you need, and when you need them. So before your next physical, spend some time preparing for the appointment and you’ll be one step ahead of the game.

1. Review your health insurance benefits. Is your plan an HMO (health maintenance organization) or provided by your company? Do you know your benefits under Philhealth? Do you have your own private health insurance? The type of program to which you subscribe may dictate many of your health-care choices. Questions to ask include: Is an annual checkup included? Do you need pre-approval from your physician for certain or all tests? What about consultations with specialists? If you don’t meet the requirements, your insurance may not pay for the tests and consultations, and you’ll be stuck with the bill.

2. Schedule wisely. Make an appointment on a day of the week and at a time when you won’t feel rushed. Consider your doctor’s schedule, too. Physicians are often swamped on Mondays, seeing people who became ill during the weekend. If you avoid booking your physical on that day, you may get a few extra minutes with the doctor. If you have a number of issues to discuss, mention it to the scheduling secretary and ask if you can book some extra time. (And if you don’t feel like your doctor had enough time to answer all your questions, schedule a follow-up appointment before you leave the office.)

3. Ask about previsit instructions. If you’re scheduled for screening tests, a number of things can affect the results. For starters, ask if you should fast or avoid specific foods, stop using over-the-counter pain medications, or abstain from sex. Alert the nurse to any medications or supplements you take occasionally or on a regular basis. For example, vitamin C supplements can cause a false-negative outcome in a fecal occult blood test to screen for colon cancer.

4. Be prepared. Write down any questions or concerns that you want to discuss with the doctor, and take them to the appointment. You may ask the following: Is my health better, the same or worse since my last visit? What are my risks for certain illnesses such as diabetes, cancer and heart disease? What screening tests should I have? What are the best ways I can maintain my health? (Ask for advice on diet, physical activity and stress management.) Do I need to update any immunizations? Should I get a flu shot or a pneumonia vaccine? (Flu shots are generally recommended yearly for people age 50 and older and for those people at higher risk of developing the flu. The pneumonia vaccine is recommended for people age 65 and older and those younger who are at increased risk.)

5. If you can, have details on your health history handy. Try to recall basic details, including data about your last physical, laboratory examination and x-ray results, special tests or procedures, medications being taken, surgeries done, and others. If you’re not certain your immunizations are up-to-date, mention that as well. And if you don’t have or can’t get your health information, resolve to start keeping track of it now.

6. Know your family’s health history. Many physicians wish more patients knew details about their family’s health. "We live in such a mobile society that people lose track of their extended family," says Alejandro Pineda, M.D., chairman of the department of family medicine of the UST Faculty of Medicine and Surgery. "But if a patient has such basic information as how long their parents, grandparents, aunts, and uncles lived, and whether there’s a family history of, say, high cholesterol or heart disease, then that will determine how we move forward." At your family’s next get-together, spend a few minutes talking about how long your grandparents, aunts and uncles lived, and how they died. It may not sound like a recipe for fun, but if you discover your family has a history of heart disease, diabetes, or breast cancer, your physician may decide to screen for such diseases at a younger age or more frequently to prevent the disease from affecting you. The more you and your doctor know about your family’s health history, the better off you’ll be.

7. Mention any allergies you’ve had, including those to food, medications, and the environment. Also discuss what kinds of reactions you’ve had and how you treated them. In diagnosing allergies, it’s important for your physician to know whether they vary to the time of the day, season, or whether there are pets or any other sources of the allergens in your home.

8. Be candid about personal health habits. Do you exercise? Use tobacco or alcohol? Do you practice safe sex? Do you sometimes wonder if you’re depressed? The more details your physician has about your lifestyle, the easier it will be for him or her to make recommendations about various screening tests. "The more we know, the more likely it is that we can be on the lookout for certain problems and get you the help you need," Edward says.

Recommended Tests

Certain screening tests are generally helpful to most people, such as blood pressure measurement. Tests recommended for older persons include lipid (cholesterol and trigycerides) levels, blood sugar, eye and hearing examination, EKG, and others. In women, additional tests may include bone mineral density (DEXA), breast exam and mammography, Pap smear, and screening for thyroid diseases. In older men, a prostate exam is usually a part of the checkup.

Controversy still exists in the medical community concerning the frequency of examinations and the ages at which to start routine screening. You may also have your own opinion on how often you need to see your doctor. The best way to determine what’s right for you is to discuss your family history and personal health priorities with your doctor. Your age, gender and individual risk factors will indicate which tests are right for you. You and your doctor can work together to determine the frequency of your health checkups and what they should include.

Today’s periodic health exam is an individualized approach to preventive medicine. It means working in partnership with your doctor to determine your personal strategy for good health.