Medical tips for an optimal annual physical exam

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By Steven E Greer, MD

Many people schedule their annual physical for either the end of the year or the start of the year. Your doctor undoubtedly delegates most of the tests and data collection to the staff, and they are often improperly performed. Some common mistakes to watch for are:

  • Make sure all of the staff washes their hands.
  • Make sure the nurse actually measures your height and weight. You likely lie to yourself about both and the nurse should not take your word for it.
  • Make sure the ECG leads are actually placed on the ankles and not on the abdomen. Nurses and most doctors often do not understand the artifacts caused by improper leads and they only glance at the ECG to look for obvious rhythm disorders. For an ECG to be of use in identifying old infarcts, the leads have to be properly placed across the chest, both arms, and both legs.
  • When they draw the blood, have them penetrate the vein at a 90-degree right angle, not close to parallel to the skin at an acute angle. A right angle works better and is less painful.
  • Make sure the doctor checks the soles of your feet the pulses in ankles. Ask your doctor to measure the “Ankle/brachial index” to pick up peripheral vascular disease in the legs.
  • Make sure the doctor looks in your ears. You probably have cerumen (wax) and you will hear those iPods better if the canals are clean. Use hydrogen peroxide dipped in Q-tips to gently clean your ears without compacting the wax deeper, or see an ear doctor if you have the luxury.
  • Particularly if you are Caucasian, make sure the doctor looks for nevi (moles) and signs of skin damage from the sun. If you are over age 40 or are younger with fair skin, this is very important. Have the doctor chart the lesions found. If you have any doubt, just go to a dermatologist and have the lesion removed. For widespread skin damage, photodynamic therapy works well.
  • If you are over age 50, go to an eye doctor to have a real eye exam where your pupils are dilated by drops. Your primary care doctor is just going through the motions by looking in your undilated eyes and cannot see much at all other than cataracts. Signs of early eye disease that will lead to blindness can only be seen when the pupils are dilated.
  • Ask about adult vaccinations for diseases such as shingles, flu, pneumonia, etc. Financial reasons have caused most primary care offices to stop administering vaccines.
  • If your doctor recommends any form of medication to prevent a cardiology problem, such as high cholesterol or high blood pressure, get a second opinion and search for the topic. In general, get a second opinion before starting any new therapy.

Weeks later, if the laboratory testing company tries to bill you, do not pay. They are not allowed to bill you for the balance of what insurance does not pay as long as your doctor is “in network”. Be generous with your doctor, however. Most primary care doctors are underpaid.

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2 Responses to Medical tips for an optimal annual physical exam

  1. fran says:

    thanks for all the informative tips….not many drs take the time to do all i appreciate the importance you put on exams and medications…..glad you are so accurate….great article….thx fran

  2. great post Dr. Greer. .you’ve just provided very well information for Physical Exam. .that i was researching for. .


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