Annual Physical Exam: The Basics
The physical exam is an essential part of any doctor's visit. Surprisingly, though, there are no absolutes in a routine physical. A good doctor may be thorough or brief, but they will spend time listening to your concerns and providing counseling for your particular complaints and risk factors.
Annual exams usually check your:
History. This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about lifestyle behaviors like smoking, excessive alcohol use, sexual health, diet, and exercise. The doctor will also check on your vaccination status and update your personal and family medical history.
Vital Signs. These are some vital signs checked by your doctor:
- Blood pressure: Less than 120 over less than 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 130 over 80 or higher.
- Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.
- Respiration rate: From 12 to 16 breaths per minute is normal for a healthy adult. Breathing more than 20 times per minute can suggest heart or lung problems.
- Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.
General Appearance. Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?
Heart Exam. Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.
Lung Exam. Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.
Head and Neck Exam. Opening up and saying "ah" shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries may also be examined.
Abdominal Exam. Your doctor can use a range of examination techniques including tapping your abdomen to detect liver size and presence of abdominal fluid, listening for bowel sounds with a stethoscope, and palpating for tenderness.
Neurological Exam. Nerves, muscle strength, reflexes, balance, and mental state may be assessed.
Dermatological Exam. Skin and nail findings could indicate a dermatological problem or disease somewhere else in the body.
Extremities Exam. Your doctor will look for physical and sensory changes. Pulses can be checked in your arms and legs. Examining joints can assess for abnormalities.
Male Physical Exam
An annual physical exam for men might also include:
- Testicular exam: A doctor can check each testicle for lumps, tenderness, or changes in size. Most men with testicular cancer notice a growth before seeing a doctor.
- Hernia exam: The famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum.
- Penis exam: A doctor might notice evidence of sexually transmitted infections such as warts or ulcers on the penis.
- Prostate exam: Inserting a finger in the rectum lets a doctor feel the prostate for its size and any suspicious areas.
Female Physical Exam
A woman's annual exam might include:
- Breast exam. Feeling for abnormal lumps may detect breast cancer or benign breast conditions. The doctor will also check the lymph nodes in the underarm area and look for visual abnormalities of the breasts and nipples.
- Pelvic exam: The pelvic exam allows examination of the vulva, vagina, cervix, uterus and ovaries. Routine checks for sexually transmitted infections are often done. A Pap test and HPV test can screen for cervical cancer and help assess risk.
There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely:
- Complete blood count
- Chemistry panel
- Urinalysis (UA)
Unless symptoms already suggest a problem, however, these tests are unlikely to provide useful information.
A screening lipid panel (cholesterol test) is recommended every 4 to 6 years, according to the American Heart Association. Your doctor might check more frequently if you have risk factors for heart disease. Abnormal cholesterol levels increase the risk for heart attacks and strokes.
If you are overweight or have any risk factors for diabetes, your blood sugar will likely be checked. The American Diabetes Association recommends that all adults, beginning at age 45, should be tested for diabetes -- regardless of weight.
The CDC recommends that everyone over the age of 18 get screened at some point for hepatitis C. This may happen during one of your physicals.
Physicals Should Emphasize Prevention
The annual physical exam is a great opportunity to refocus your attention on prevention and screening:
- At age 45, it's time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer or other risk factors may need to be screened before age 45.
- For some women, age 40 marks the time to begin annual mammogram screening for breast cancer. The American Cancer Society recommends that women ages 40 to 44 should have the choice to start mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year while women 55 and older should switch to mammograms every 2 years, or can continue yearly screening. Women should talk to their doctor or other health care professional about when to start and how often to get a mammogram. There are different guidelines for breast cancer screening depending on your personal risk for getting breast cancer and whose guidelines you chose to follow. Women should weigh the benefits and risks of screening tests when deciding whether to begin getting mammograms at age 40.
Healthy behaviors work far better than medicine at preventing illness, and don't require a prescription:
- Do 30 minutes of brisk walking or other exercise most days of the week (or about 150 minutes a week). And add in some strength training at least twice a week. Your risk for cardiovascular disease, diabetes, and some types of cancer will fall dramatically.
- Eat a mostly plant-based diet, low in animal fats.
- Above all, don't smoke.
Do You Even Need An Annual Physical Exam?
The annual physical exam is beloved by many people and their doctors. But studies show that the actual exam isn't very helpful in discovering problems and may lead to unnecessary tests.
Leading doctors and medical groups have called the annual physical exam "not necessary" in generally healthy people.
Exercising, keeping a healthy weight, and not smoking are enough to keep most of us in good health, with or without an annual exam. Still, no one can argue with keeping up a good relationship with your doctor through regular visits. As long as you and your doctor are paying attention to prevention and your overall health, the details are up to you.