What to Expect at an Annual Exam

It’s that time of year again, and you’re due for your annual exam. Whether you’re 20 or 80, you may wonder what to expect or how to prepare for your exam. The recommendations vary by age and gender, along with other risk factors. Knowing what to expect will help you prepare to use your time with your doctor effectively and efficiently.

The goal

The physical exam aims to determine your health risks and determine what tests are appropriate for the early detection and prevention of diseases. It helps your doctor make recommendations on improving your health by modifying your lifestyle or possibly taking medication. The annual physical is also a good opportunity for your doctor to get to know you and discuss things like your healthcare directives and wishes. It’s also an opportunity to review any health conditions you currently have.

The physician will use screening tests in patients with no diagnosis of the potential condition. In patients diagnosed with the condition, the testing is considered surveillance.

The basics

Nearly every visit to your doctor starts with vital signs. This includes your weight, your blood pressure, your pulse, and possibly your temperature and your oxygen levels. The staff will also review your medical history, family history, medications, and habits, such as the use of cigarettes, alcohol, or drugs. They may ask about your sexual history or habits. The recommendations for health maintenance and testing may differ depending on these behaviors.

The physical exam

The vital signs are the first step in your physical exam. Your healthcare provider will examine your heart and lungs. Depending on the type of physical, you may need your eyes checked. They may look in your ears, listen to your neck, or feel the pulses in your extremities. They may look at your skin to make sure you don’t have any skin cancers or precancerous lesions. Blood pressure checks should be done at least once a year. The recommendations for normal blood pressure vary based on several factors including age, other medical conditions, and how the blood pressure is checked. Screening for obesity is done based on a measurement called body mass index (BMI). This is calculated based on your height and weight.

Pap smears are recommended every three years in people aged 21-30 who have a uterus. If you’ve ever had an abnormal pap, then the exam should be annual. Over the age of 30, pap smears can be extended to every 5 years as long as you’ve never had an abnormal pap and your HPV test (done on the pap smear) is negative and you don’t have new partners. Abnormal pap smears are usually associated with the HPV virus. Before the age of 21, women or people assigned female at birth (AFAB) are likely to clear the HPV virus without treatment. In women and AFAB who have never had an abnormal pap, pap smears can stop at age 65. Pap smears are done to screen for cervical cancer. If abnormal cells are seen, the goal is to treat and remove the abnormal cells before they progress to cancer. A pap smear only checks for cancers of the cervix, not cancers of the ovaries or uterus. A pelvic exam may also include feeling your uterus and ovaries with a bimanual exam (the healthcare provider puts fingers on the inside of the vagina and presses down on the abdomen sandwiching the uterus between the hands).

In patients who have a prostate, there is no longer a recommendation for routine digital rectal exams (putting a finger in the rectum to feel the prostate gland). However, if there are additional symptoms such as trouble urinating then your doctor may choose to examine the prostate.

Clinical breast exam (feeling the breasts for lumps or other abnormalities) is no longer recommended routinely for screening by most organizations. These have not been shown to improve detection rates for breast cancer.

The labs

Cholesterol testing should be used in men aged 20-25 and women aged 20-45 who have a family history of heart disease under age 50 in male relatives or age 60 in female relatives or people who use tobacco or have high blood pressure. How often cholesterol should be checked is somewhat controversial, but the longest interval recommended is at least every five years. When to stop screening has also not been established. Treating high cholesterol helps prevent heart disease.

Thyroid screening is recommended starting at age 35 and every five years after by the American thyroid association. Other organizations recommend screening at different ages. The American Academy of Family Physicians recommends against routine screening in patients under age 60.

Screening for anemia is recommended for children and pregnant women, though this is somewhat controversial. There is no recommended screening for anemia in non-pregnant, asymptomatic adults.

Diabetes screening is recommended every three years in overweight or obese patients who are aged 40-70. This screening can be done with a metabolic panel or a hemoglobin A1c. Some guidelines suggest starting this screening in patients who have high blood pressure or high cholesterol at age 35.

Gonorrhea and chlamydia screening is recommended in all sexually active women less than 25 or sexually active women over 25 with risk factors such as history of previous infection, new or multiple sex partners, a sex partner with other partners, exposure to sexually transmitted diseases, or people who exchange sex for drugs or money.

Testing for hepatitis B is recommended once in adults over age 18. Testing for hepatitis C is recommended once for adults 18-79.

HIV testing is recommended in all pregnant women and people aged 15-65 at least once. In people who are at higher risk, testing should occur more often. Syphilis testing is recommended in pregnant women and people who are at high risk.

Prostate cancer screening with a PSA lab test is no longer routinely recommended in asymptomatic individuals who are of average risk. There is the potential to do more harm than good by diagnostic procedures and treatment for low-grade prostate cancers.

The psychosocial screens

Current guidelines recommend depression and anxiety screening annually. Your doctor can do questionnaires with you. This screening is recommended for both adolescents and adults. Part of the social history questions asked at the beginning of your appointment looks for substance use problems. Your doctor may also ask about intimate partner violence.

This is also a good time to talk with your doctor about healthcare directives and powers of attorney. Your doctor should know your wishes if you develop a life-threatening medical condition or are unable to consent to treatment.

The imaging

Depending on your gender, age, and risk factors, your doctor may recommend different types of imaging tests.

Mammograms

Traditionally, mammograms have been recommended yearly starting at age 40 or sooner if you have a family member that was diagnosed with breast cancer. A few years ago, the U.S. preventative services task force (USPSTF) changed its recommendation, which created some controversy between that organization and other organizations such as the American Cancer Society and the American College of Radiology. Very recently, the USPSTF reversed course and mammograms are again recommended starting at age 40 in average-risk women.

Bone density

Screening for osteoporosis with a bone density study is recommended starting in women aged 65 or older. Women under age 65 who are at increased risk of osteoporosis should also be screened. There is not currently a recommendation to screen men for osteoporosis unless they are at high risk. Screening should be performed about every 5 years.

Ultrasound to rule out abdominal aortic aneurysm

In men who have ever smoked, screening for an abdominal aortic aneurysm (AAA) is recommended one time between age 65-75. There is also a recommendation for men 65-75 who have never smoked but who have a parent, sibling, or child who needed to have a AAA repaired or who died from a ruptured AAA.

The procedures

Routine electrocardiogram (ECG or EKG) is not routinely recommended in people without symptoms, but it is frequently done at the initial Medicare physical done within the first 6 months of being enrolled in Medicare.

Colon cancer screening is recommended in average-risk people over age 45. If you have a family history of colon cancer, screening may be recommended earlier. It is important to note that the recommendation for screening was recently lowered to age 45. It was previously at age 50. Several screening tests can be used that range from stool collection studies to colonoscopy. The frequency of screening and the determination of which test to use depends on your risk factors and the test that is used.

The immunizations

Here are the recommendations for immunizations:

• The flu shot is recommended annually for all adults and children.
• Tetanus, diphtheria, and acellular pertussis (Td/Tdap) are recommended for all adults 19 and older who have not received it previously. After that, it’s recommended every 10 years unless you sustain an injury or are pregnant.
• Varicella (chickenpox) vaccination is recommended in people over age 13 who have never had chickenpox or the childhood varicella vaccine series.
• Human papillomavirus vaccines (HPVs) are recommended for people aged 11-26.
• Zoster (shingles) vaccine is recommended for most people over age 50. The new two-shot series is recommended over the older vaccine. If you received the one-shot shingles vaccine, you should be vaccinated with the two-shot series because it is more effective.
• Pneumococcal (pneumonia) vaccines are recommended for all adults over 65 and 19- to 64-year-olds with high-risk conditions.
• Meningococcal vaccination is recommended for most adolescents or adults.
• Hepatitis B vaccination is recommended for all adults less than 60 or adults 60 or older who are at increased risk.
• COVID-19 vaccination and boosters are recommended for all adults.
• Respiratory syncytial virus (RSV) vaccination was just released and approved by the U.S. Food and Drug Administration in adults 60 and older. This vaccine has not yet been added to the formal recommendations because it is pending review by the CDC.

When not to test

The USPSTF makes guidelines about at what age to consider stopping testing. However, age isn’t the only consideration. Your overall health makes a difference in recommendations too. Most of the screening tests are recommended for patients with a life expectancy of at least 10 years. This means that if you are healthy, you may want to consider continuing to screen after the recommended age. On the other hand, if you are in very poor health, you may want to consider stopping screening early. Ultimately, the decision should be a discussion between you and your healthcare provider.

This article is designed to serve as a guideline to facilitate discussion between you and your healthcare provider as you schedule your annual exam. If your provider has diagnosed you with a chronic medical condition, you may have additional discussions about treatment options including medications. If you’re on medications, you may be looking for the least expensive options for getting your medications. Consider visiting us at ScriptSave WellRx. Some people save a little. Some people save a lot. Prices vary across zip codes. Even pharmacies across the street from each other can have huge price differences. We aim to bring transparency to prescription medication pricing, helping consumers keep more money in their pockets. ScriptSave has been helping consumers save on their prescriptions for 25 years.

Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

1. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-pap-smears.html#:~:text=The%20USPSTF%20recommends%20screening%20for,5%20years%20(A%20recommendation).
2. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-prostate-cancer.html
3. https://www.komen.org/breast-cancer/screening/when-to-screen/average-risk-women/#breast-cancer-screening-recommendations
4. https://www.aafp.org/pubs/afp/issues/2002/0115/p273.html#:~:text=Screening%20is%20recommended%20for%20men,%2C%20tobacco%20use%2C%20hypertension).
5. https://www.aafp.org/pubs/afp/issues/2004/0515/p2415.html#:~:text=The%20American%20Thyroid%20Association20,high%2Drisk%20or%20symptomatic%20individuals.
6. https://www.ncbi.nlm.nih.gov/books/NBK499905/
7. https://www.aafp.org/pubs/afp/issues/2016/0115/p103.html#:~:text=The%20U.S.%20Preventive%20Services%20Task,years%20if%20results%20are%20normal.
8. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening
9. https://www.aafp.org/pubs/afp/issues/2011/0515/p1197.html