Periodic Health Examination Health Article

PERIODIC HEALTH EXAMINATION

The purpose of the periodic health examination is to evaluate health status, screen for risk factors and disease, and provide preventive counseling interventions in an age-appropriate manner. The goal of screening and evaluation is to prevent the onset of disease or the worsening of an existing disease. For example, measurement of blood pressure is intended to detect hypertension so as to initiate treatment and prevent subsequent morbidity (e.g., stroke or renal failure) or mortality. A further goal of the periodic health examination is to educate patients about behavioral patterns or environmental exposures that pose risks for future diseases. Examples include counseling about smoking prevention and cessation to prevent lung cancer and emphysema, seat belt use to prevent motor-vehicle injuries, or modifying sexual practices to prevent the spread of sexually transmitted disease.

In the 1920s the American Medical Association first proposed a yearly, routine physical examination (check-up) for healthy patients. However, there have always been questions about exactly what to include in routine check-ups, and whether they are beneficial. An important principle of clinical medicine is to "do no harm." This is a particular concern when considering testing and counseling in well persons. In 1976, the Canadian Task Force on the Periodic Health Examination was formed to provide a systematic evaluation and recommendations about periodic health exams. The United States Preventive Services Task Force (USPSTF) was formed in 1984 to provide similar guidelines in the United States. The most recent recommendations of the USPSTF for evaluation, screening, and counseling interventions were published in 1996. Input was provided by primary-care medical societies, the U.S. Public Health Service, and the Canadian Task Force on the Periodic Health Examination. These recommendations are based on available evidence of safety and efficacy, and are tailored for patients based upon their individual age, gender, and risk-factor characteristics. Key summary findings of the USPSTF include:

1. Effective interventions that address the patient's individual health behaviors are most important for preventing the leading causes of death and disability (e.g., interventions to prevent smoking, alcohol, and other drug use; encourage use of seat belts; and encourage increased physical activity and appropriate nutrition).
2. The patient and clinician should share responsibility for weighing risks and benefits when deciding about screening and diagnostic testing and preventive interventions.
3. To maximize benefits and avoid doing harm, clinicians should be selective in choosing screening tests and other preventive services for their patients.
4. Special efforts should be taken to provide preventive services to people with less access to care.
5. Community-level public health and public-policy interventions may be more effective for some health problems than interventions delivered in the clinical setting (e.g., community educational interventions to prevent the initial onset of cigarette smoking by children, and seat belt use legislation).

Tables 1, 2, and 3 show the recommended components of the periodic health examination for children, women, and men. The clinical preventive services addressed in these tables are in the areas of immunizations, screening, and counseling. The following are some examples of preventive services offered in these categories, for specific groups.