A User's Guide to Your Physical Exam

July 7, 2010— -- ABC News' senior health and medical editor Dr. Richard Besser recently visited his own doctor, and learned that a checkup is not as simple as it once was. Here are a few tips on what to expect at your visit.

The Visit and Physical Exam

Your visit with your primary care provider (PCP) usually starts with you talking about why you are there. This is your opportunity to discuss your particular concerns. You will also discuss your medical and surgical and family history.

You can expect a physical exam that includes an assessment of your blood pressure, height and weight, and other important "vital signs" like your heart rate and temperature. For your first visit, your PCP may also examine your heart, lungs, abdomen and other systems during the exam.

What Tests, Screenings and Vaccines Should You Get?

Health screenings are meant to detect disease in the early stage to be treated early. They are tests that are not risky.

Immunizations are another preventive health service that are offered to most patients and are meant to prevent and protect against disease. Most people don't realize that vaccines are not just for children; there are important shots adults need to get too.

Recommended screenings and immunizations vary by age group and risk factors. Here are some important tests, screenings and vaccines by age group that apply to most people without increased risks.

20-40s

Cervical cancer screening (PAP smear) for women who are sexually active

Meningococcal vaccine for college students living in a dormitory

Varicella vaccine for those who have never had chicken pox

Tetanus, pertussis, diphtheria booster immunization

Human Papilloma Virus (HPV) vaccine for women 19-26 if not previously vaccinated

Cholesterol screening for those 35 years old and up

HIV testing

50s

Seasonal influenza vaccine

Colon and rectal cancer screening (colonoscopy or fecal testing)

Breast cancer screening (mammogram) for women

Cholesterol screening (blood test)

Cervical cancer screening (PAP smear) for women who are sexually active

Tetanus, diphtheria, pertussis booster immunization

Varicella vaccine for those who have never had the chicken pox

HIV testing

60s and Later

Herpes zoster vaccine

Pneumonia vaccine for those 65 years and older

Osteoporosis screening (DEXA scan) for women 65 years and older

Colon and rectal cancer screening (colonoscopy or fecal occult blood testing)

Breast cancer screening (mammogram) for women

Cholesterol screening

Tetanus, pertussis, diphtheria booster immunization

Varicella vaccine for those who have never had the chicken pox

Seasonal influenza vaccine

HIV testing

If you have increased risk or have a family history of certain diseases, or if you smoke or are overweight or obese, these screens and tests may be performed earlier. If you are pregnant or have a weakened immune system, certain vaccines may not be given to you, and you may also need additional vaccines.

There are a lot of screenings and vaccinations that may be appropriate for you, even on your first visit. Sometimes it can be overwhelming on a first visit and knowing what to expect helps.

If it feels like too much for you, ask your PCP to hold off on some of it until the next visit. Similarly, your PCP may postpone some things (1) until he/she establishes a good rapport with you -- especially on sensitive issues such as cancer; and/or (2) if you have more immediate pressing health needs that require attention first.

Some screenings have gained attention because the recommendations have recently changed due to new evidence. For example, if you are a man younger than 75, prostate cancer screening is one that should be discussed with your PCP because of the uncertainty about the benefits of treating prostate cancer detected in those who have no symptoms.

Some doctors think that prostate cancer is overdiagnosed and that testing with PSA (prostate specific antigen blood test) picks up small cancers that in some cases may not go on to harm you. However, in some cases prostate cancer can go on to cause serious harm or death, and we currently don't have great ways of knowing which will and which won't when they are small. Once one has tested positive there are significant psychological burdens associated, even if it is decided to "do nothing" and just monitor the cancer.

Prostate cancer treatment options are also associated with risk of erectile dysfunction, urinary incontinence, bowel dysfunction, and in rare cases death. For these reasons, many men decide not to be tested unless they have symptoms of disease such as frequent urination or difficulty urinating. Talk with your doctor about this test to see what is right for you.

The screening and vaccination recommendations were adapted from the from the US Preventative Task Force and CDC recommendations. For full details, please visit http://www.ahrq.gov/clinic/uspstf/uspstopics.htm#Otopics and http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm.