Your health is your most important asset. That's why at Allina Health we recommend regular physical exams for adults.
In this segment, Dr. Leslie Swartz-Williams discusses how at your visit, you'll meet with your care provider to ensure you're up-to-date on health screenings, identify risks for future health concerns, review your medicines, and set wellness goals.
Annual Physicals: What You Need to Know
Featured Speaker:
Learn more about Leslie Swartz-Williams, MD
Leslie Swartz-Williams, MD
Leslie Swartz-Williams, MD is a board-certified internal medicine physician with professional interests in preventive medicine, total care of complex patients and geriatric care.Learn more about Leslie Swartz-Williams, MD
Transcription:
Annual Physicals: What You Need to Know
Melanie Cole (Host): Your health is your most important asset. That’s why at Allina Health, we recommend regular physical exams for adults. My guest today is Dr. Leslie Swartz-Williams. She’s a board certified Internal Medicine Physician at Allina Health. Welcome to the show, Dr. Swartz-Williams. So let’s speak about these regular physical exams for adults because we hear with children we bring them in every year for their well-visits, but adults don’t always think that they need to go in. What’s your best advice and most important information to start out with about getting those annual physicals?
Dr. Leslie Swartz-Williams (Guest): Well, for adults we recommend that blood pressure and weight be monitored. If blood pressure and weight are doing well, then people can get by with a general physical a couple of times in their twenties, with the exception being that women should have a pelvic examination every three years or so. If everything is going very well, then a person should be seen two, three times in their twenties, about three times in their thirties, probably about the same number in their forties, and then annually after 50. It’s more important that we see people annually after the age of 50, a little bit less frequently -- provided they’re in very good health – in the younger years.
Melanie: So then let’s start with when we do get that physical we always see that they’re going to take a blood test and get a blood sample for many different things that they’d like to check. What should we be sure is in that chemistry panel and complete blood count?
Dr. Swartz-Williams: The two primary labs that we will follow when we’re doing physical examination is an evaluation of cholesterol, and if there is any indication that the patient is at risk for diabetes, then we’ll check a fasting blood sugar. The majority of the other tests that are ordered are based on indications of some potential problem that we’d be looking for.
Melanie: So when you say fasting blood sugar, and also people hear A1c, and we know diabetes is such a problem in this country today and obesity is actually an epidemic in the country, so do you recommend taking the A1c and who, if you do, would you recommend getting that?
Dr. Swartz-Williams: I would do an A1c if the patient was at high risk and for some reason, we didn’t think that a fasting blood sugar would give us an adequate reading. There are three ways of defining diabetes; an A1c is one of them. A fasting blood sugar is the second one, and then we can do what’s called a two-hour glucose tolerance test. Any one of those can give us a diagnosis of diabetes. However, any one of them can also be an error and over-diagnose diabetes, so you have to choose your tests carefully, and it really depends on the entire circumstances of the patients, their exercise, their height, weight, family history, and a variety of things along those lines.
Melanie: So sticking with blood lab tests for a minute, as we get older and our risk for certain things increases, there are some predictors of heart disease that people have questions about – homocysteine, CRP – do you take these as a regular, or is it based on a family history or health history of that patient?
Dr. Swartz-Williams: No they’re not recommended to be taken on a regular basis. There’s very weak data that these provide additional information beyond what we can ascertain by smoking history, the risk for heart disease based on diabetes, family history, the basic cholesterol testing. Those tests provide additional information, but they rarely, rarely will throw you from, “I don’t think this patient needs to be treated,” into “Gosh, we’ve got to start treatment right away.”
Melanie: Speak about cholesterol and the blood work there, what do those numbers mean for the listeners?
Dr. Swartz-Williams: The total cholesterol is what most people focus on, but it’s really not the most important number. What we are shifting our focus to is the ratio of the total cholesterol to the good cholesterol with an eye toward what does the bad cholesterol or LDL, look like? We use a ratio to compare all of these numbers. The total cholesterol can be very high, and that’s okay if the good cholesterol is very high. If the good cholesterol is low and the bad cholesterol is high, then the ratio is going to be very poor and will determine that the patient is at some degree of increased risk for heart disease. We have algorithms that we use that help to guide us to what is a low-risk, moderate-risk, and high-risk, and for people who are in the moderate-risk, that would be where we might consider additional testing.
Melanie: And what about for men specifically, do they need a PSA, and if so, when?
Dr. Swartz-Williams: PSAs are even more controversial than probably any other test out there right now. If there’s a family history of prostate cancer, or with African Americans, we can start screening as early as 50, otherwise we can consider screening with the PSA blood test after age 50. It is very controversial because there are not any good studies that show benefit from screening men with a PSA in preventing the rate at which men die from prostate cancer.
The American Urology Association has continued to lean toward recommending the PSA, but other organizations think that the risk of falsely positive test results and the anxiety of further testing, and complications from those tests outweigh the benefits. That is a test that definitely needs to be individualized to the patient with their concern and their family history.
Melanie: And what about a Hepatitis C? Should people be checked for that at some point in their lives?
Dr. Swartz-Williams: There is a recommendation now that people between the ages of – people who were born between the year 1945 and 1965 be checked once for Hepatitis C. That disease is more prevalent than Hepatitis B and is a significant contributor to both cirrhosis and liver cancer, so a one-time screening test is recommended.
Melanie: And for women, what do you recommend that they do yearly as far as mammograms or self-exams – we’re talking about the annual physical, but that does include certain women-specific things.
Dr. Swartz-Williams: Mammograms are something that we’ve been backing away from recommending them quite as frequently as we used to. That’s due to some recent studies that came out and indicated that most cancers are not as fast and aggressive as they were all presumed to be, so, between the ages of 50 and 65, women are usually okay to have a mammogram every other year unless they are at high risk. Mammogram is between 40 and 50 need to be individualized to the patient’s individual risk and mammograms after 75 are definitely something that needs to be individualized to the person’s risk and life-expectancy and individual desires.
Melanie: And Dr. Swartz-Williams, do you recommend at this annual physical – and mainly speak about the over-50 crowd – that they get an EKG or a chest X-ray at their annual physical?
Dr. Swartz-Williams: We do not recommend annual chest X-rays for anybody. They have been proven to not provide us any useful information. The EKG can be done as a baseline, but that’s also something we will do on more of an as-needed basis.
Melanie: And what about lifestyle? Do you discuss with your patient’s lifestyle modifications? Wrap it up for us, what you would like listeners to know about discussing things, partnering with their healthcare provider to be their own best health advocate.
Dr. Swartz-Williams: Lifestyle and exercise and diet modifications are one of my favorite areas to get into because that’s something where people have a lot of misconceptions, or they’ve tried things, and they’ve failed, and they don’t know what they can do next, or what to try alternatively. There’s a lot of good information out on the internet, and there’s a lot of misinformation, so talking with the person about what their weight goals are, what their exercise goals are, what they’ve tried and what they want to do. How we can move forward with maximizing one’s health using diet and exercise is something that is really a very, very good topic for a general physical or wellness examination.
Melanie: And what would you like people to ask their providers at that annual physical?
Dr. Swartz-Williams: That’s an excellent question. There are so many different people that have different concerns, but it is very good to discuss the benefits of screening tests, the risks involved in the screening tests, and what else can we do to live long, healthy lives where we’re not feeling decrepit and old and always be trying to maintain what we have today for as long as possible.
Melanie: Thank you, so much, for being with us today. That’s great information and so important for listeners to hear. You’re listening to the Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much, for listening.
Annual Physicals: What You Need to Know
Melanie Cole (Host): Your health is your most important asset. That’s why at Allina Health, we recommend regular physical exams for adults. My guest today is Dr. Leslie Swartz-Williams. She’s a board certified Internal Medicine Physician at Allina Health. Welcome to the show, Dr. Swartz-Williams. So let’s speak about these regular physical exams for adults because we hear with children we bring them in every year for their well-visits, but adults don’t always think that they need to go in. What’s your best advice and most important information to start out with about getting those annual physicals?
Dr. Leslie Swartz-Williams (Guest): Well, for adults we recommend that blood pressure and weight be monitored. If blood pressure and weight are doing well, then people can get by with a general physical a couple of times in their twenties, with the exception being that women should have a pelvic examination every three years or so. If everything is going very well, then a person should be seen two, three times in their twenties, about three times in their thirties, probably about the same number in their forties, and then annually after 50. It’s more important that we see people annually after the age of 50, a little bit less frequently -- provided they’re in very good health – in the younger years.
Melanie: So then let’s start with when we do get that physical we always see that they’re going to take a blood test and get a blood sample for many different things that they’d like to check. What should we be sure is in that chemistry panel and complete blood count?
Dr. Swartz-Williams: The two primary labs that we will follow when we’re doing physical examination is an evaluation of cholesterol, and if there is any indication that the patient is at risk for diabetes, then we’ll check a fasting blood sugar. The majority of the other tests that are ordered are based on indications of some potential problem that we’d be looking for.
Melanie: So when you say fasting blood sugar, and also people hear A1c, and we know diabetes is such a problem in this country today and obesity is actually an epidemic in the country, so do you recommend taking the A1c and who, if you do, would you recommend getting that?
Dr. Swartz-Williams: I would do an A1c if the patient was at high risk and for some reason, we didn’t think that a fasting blood sugar would give us an adequate reading. There are three ways of defining diabetes; an A1c is one of them. A fasting blood sugar is the second one, and then we can do what’s called a two-hour glucose tolerance test. Any one of those can give us a diagnosis of diabetes. However, any one of them can also be an error and over-diagnose diabetes, so you have to choose your tests carefully, and it really depends on the entire circumstances of the patients, their exercise, their height, weight, family history, and a variety of things along those lines.
Melanie: So sticking with blood lab tests for a minute, as we get older and our risk for certain things increases, there are some predictors of heart disease that people have questions about – homocysteine, CRP – do you take these as a regular, or is it based on a family history or health history of that patient?
Dr. Swartz-Williams: No they’re not recommended to be taken on a regular basis. There’s very weak data that these provide additional information beyond what we can ascertain by smoking history, the risk for heart disease based on diabetes, family history, the basic cholesterol testing. Those tests provide additional information, but they rarely, rarely will throw you from, “I don’t think this patient needs to be treated,” into “Gosh, we’ve got to start treatment right away.”
Melanie: Speak about cholesterol and the blood work there, what do those numbers mean for the listeners?
Dr. Swartz-Williams: The total cholesterol is what most people focus on, but it’s really not the most important number. What we are shifting our focus to is the ratio of the total cholesterol to the good cholesterol with an eye toward what does the bad cholesterol or LDL, look like? We use a ratio to compare all of these numbers. The total cholesterol can be very high, and that’s okay if the good cholesterol is very high. If the good cholesterol is low and the bad cholesterol is high, then the ratio is going to be very poor and will determine that the patient is at some degree of increased risk for heart disease. We have algorithms that we use that help to guide us to what is a low-risk, moderate-risk, and high-risk, and for people who are in the moderate-risk, that would be where we might consider additional testing.
Melanie: And what about for men specifically, do they need a PSA, and if so, when?
Dr. Swartz-Williams: PSAs are even more controversial than probably any other test out there right now. If there’s a family history of prostate cancer, or with African Americans, we can start screening as early as 50, otherwise we can consider screening with the PSA blood test after age 50. It is very controversial because there are not any good studies that show benefit from screening men with a PSA in preventing the rate at which men die from prostate cancer.
The American Urology Association has continued to lean toward recommending the PSA, but other organizations think that the risk of falsely positive test results and the anxiety of further testing, and complications from those tests outweigh the benefits. That is a test that definitely needs to be individualized to the patient with their concern and their family history.
Melanie: And what about a Hepatitis C? Should people be checked for that at some point in their lives?
Dr. Swartz-Williams: There is a recommendation now that people between the ages of – people who were born between the year 1945 and 1965 be checked once for Hepatitis C. That disease is more prevalent than Hepatitis B and is a significant contributor to both cirrhosis and liver cancer, so a one-time screening test is recommended.
Melanie: And for women, what do you recommend that they do yearly as far as mammograms or self-exams – we’re talking about the annual physical, but that does include certain women-specific things.
Dr. Swartz-Williams: Mammograms are something that we’ve been backing away from recommending them quite as frequently as we used to. That’s due to some recent studies that came out and indicated that most cancers are not as fast and aggressive as they were all presumed to be, so, between the ages of 50 and 65, women are usually okay to have a mammogram every other year unless they are at high risk. Mammogram is between 40 and 50 need to be individualized to the patient’s individual risk and mammograms after 75 are definitely something that needs to be individualized to the person’s risk and life-expectancy and individual desires.
Melanie: And Dr. Swartz-Williams, do you recommend at this annual physical – and mainly speak about the over-50 crowd – that they get an EKG or a chest X-ray at their annual physical?
Dr. Swartz-Williams: We do not recommend annual chest X-rays for anybody. They have been proven to not provide us any useful information. The EKG can be done as a baseline, but that’s also something we will do on more of an as-needed basis.
Melanie: And what about lifestyle? Do you discuss with your patient’s lifestyle modifications? Wrap it up for us, what you would like listeners to know about discussing things, partnering with their healthcare provider to be their own best health advocate.
Dr. Swartz-Williams: Lifestyle and exercise and diet modifications are one of my favorite areas to get into because that’s something where people have a lot of misconceptions, or they’ve tried things, and they’ve failed, and they don’t know what they can do next, or what to try alternatively. There’s a lot of good information out on the internet, and there’s a lot of misinformation, so talking with the person about what their weight goals are, what their exercise goals are, what they’ve tried and what they want to do. How we can move forward with maximizing one’s health using diet and exercise is something that is really a very, very good topic for a general physical or wellness examination.
Melanie: And what would you like people to ask their providers at that annual physical?
Dr. Swartz-Williams: That’s an excellent question. There are so many different people that have different concerns, but it is very good to discuss the benefits of screening tests, the risks involved in the screening tests, and what else can we do to live long, healthy lives where we’re not feeling decrepit and old and always be trying to maintain what we have today for as long as possible.
Melanie: Thank you, so much, for being with us today. That’s great information and so important for listeners to hear. You’re listening to the Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much, for listening.