The Periodic Physical Examination in Asymptomatic Adults

Abstract

The components of the periodic physical examination have been evaluated according to contemporary epidemiologic standards. For the asymptomatic, nonpregnant adult of any age, no evidence supports the need for a complete physical examination as traditionally defined. The efficacy for three screening procedures has been established: Blood pressure should be measured at least every 2 years; women more than 40 years of age should have a breast examination done by a physician annually; and sexually active women should have a pelvic examination and a Papanicolaou test at least every 3 years after two initial negative tests have been obtained 1 year apart. Because of the prevalence and morbidity of specific diseases, and the sensitivity and specificity of screening tests, several other maneuvers are recommended for screening asymptomatic adults, although the optimal frequency has not been determined experimentally. Weight should be measured every 4 years. Visual acuity should be tested annually in adults older than 60 years of age. To identify patients at high risk for melanoma, a complete skin examination should be done once. Hearing should be tested by audioscope annually in adults older than 60 years of age. Physicians should encourage patients to have annual dental visits. To identify valvular abnormalities requiring antibiotic prophylaxis, cardiac auscultation should be done at least twice in an adult. Men older than 60 years of age should have a yearly examination of the abdomen for the presence of aortic aneurysm. Although the other components of the complete physical examination may be important in establishing and maintaining the physician-patient relationship, they have not been shown to be effective screening maneuvers for asymptomatic disease.

The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm

“…2 Abdominal palpation during physical examination is an important means of AAA detection, accounting for about one third of new diagnoses. 3 Palpation for AAA is one of the few physical examination maneuvers recommended for the periodic health examination of older men, 4 and may be more cost-effective for screening than ultrasound. 5 The literature on the accuracy of abdominal palpation for AAA has recently been reviewed, 6 but important questions remain.…”

Low rate of non-attenders to primary care providers in Israel - a retrospective longitudinal study

“…Surveys show that both patients and physicians expect and value annual visits to a PCP [13-15]. Moreover, individuals who receive annual examinations were found to feel better, behave healthier, undergo more appropriate screening, and trust their physicians more than patients who did not have annual examinations [13,16].…”

“…Moreover, individuals who receive annual examinations were found to feel better, behave healthier, undergo more appropriate screening, and trust their physicians more than patients who did not have annual examinations [13,16]. Recently, Medicare enrollees who did not visit a primary care physician during a one year period were reported to be less likely to be tested for colorectal cancer than those who did visit [17].…”

The Value of Screening for Prostatic Carcinoma: A Commentary

“…The adult preventive medicine examinations now be ing developed in the United States do not require routine rectal examinations [31]. Worldwide, the International Union against Cancer (UICC) has succinctly summed up the situation: 'Not only has an acceptable and valid screening test to be developed, but an acceptable and effective treatment for the preclinical lesions found as a result of screening has to be developed ...…”