—Jamie P.*, University of Windsor, Ontario
It’s good to know what you’re about to walk into for any doctor’s appointment. Though routine, checkups can be a little scary for some. First, let’s define what a “checkup” is.
A checkup is usually performed on a healthy person who wants to eliminate the possibility of any medical problems—it’s a preventive health care visit. If the person has one or more medical concerns, then it’s no longer a preventive visit because the patient is asking the provider to diagnose them with something and provide a management plan for the problems. These two types of visits can be the same, but they can also be different.
A preventive care visit can be divided into several parts:
1. The introduction. This consists of asking why you’re coming and if you have any concerns you want to address. The intro is to establish what your expectations are for the visit. For example, if a patient wants a total body MRI to rule out all cancers, I would probably answer that this is unrealistic because an MRI helps me make a diagnosis and I have to tell the radiologist what to look for. Once we have figured this out, we move on to…
2. Gathering information. This portion consists of finding out a person’s past medical history. That is, has anything happened to this person in the past that may increase their risks of problems in the future? This is followed by a family history to rule out any genetic issues that can again have an impact on their health. Of course, I would want to know about allergies; immunization status; current medication intake; social habits; tobacco, alcohol, and drug use; the environment they work or study in; eating habits; exercise; and mental health status. Then we would ask about problems with every part of the body. This is probably the part of the visit that provides us with the most useful information.
3. Physical examination. The is the objective portion of the visit. It would include evaluating blood pressure, heart rate, weight, and height. Some practitioners may include a few other things, but these are the basics. Then all parts of the body are checked, such as the head, eyes, ears, nose, throat, neck, chest, cardiovascular system, abdomen, genitals, arms, and legs.
4. Series of tests. What will be ordered, if anything, will depend on the information gathered to date, your age, and sex. For example, if the person has a strong family history of high cholesterol at a very early age, then a lipid profile will be ordered. If a female has very heavy and long periods, then a complete blood count and iron test may be ordered. If a person describes engaging in risky sexual behaviour (such as unprotected sex) or asks for a test for sexually transmitted infections (STIs), then these are included in the list.
If you’re between the ages of 15 and 25, there aren’t any tests we order routinely in everyone (though annual STI tests are suggested). When a person reaches 40, then that triggers certain tests, and as they proceed through to 50, we have more. Then, as they get to 65, we start taking some away. Gender also affects what we will do.
5. Counselling. What is said here in the final stage of a checkup depends on the same things that dictate the choice of tests. This may include discussing smoking cessation (quitting smoking), doing more physical activities, using protective gear when doing sports, getting immunized, safer sex practices, and/or contraception. The practitioner should tell you what you’re doing well and what needs to be improved. The visit should end with your questions, if you have any.
This is my vision of a routine checkup, as well as that of the College of Family Physicians of Canada and several other medical associations.