Preventive Visits (Physicals) and what it means for you!

The Good news about Preventive Visits/Physical/Well-Visits!

Have you heard the good news- “Preventive Visits” are 100% free to you! That sounds like great news doesn’t it?  It is, but it’s very important to know what “preventive” means so you can take full advantage of the opportunity.  The easiest way to determine what is a preventive visit (versus diagnostic) is to think of it as an information gathering visit to determine what your current state of health and well-being is and how it corresponds to other people of your age and gender. It’s best to do it when you are feeling well (thus the common moniker “well-visit”), you don’t have any current or new health concerns to discuss during the visit (thus no change in medication, no new prescriptions are given, no normal screening labs are ordered),  and /or no follow-up for a health issue discussed during the visit is scheduled.   For example, during your Physical/Preventive/Well-Visit, your doctor may notice that you are at risk for diabetes and have not been tested.  Your doctor then decides to test you. That screening/testing is part of your preventive visit.  However, if you are diabetic and you are at your Physical/Preventive/Well-visit and you are having complications due to your diabetes that are addressed by your doctor, that preventive/physical visit is now two visits: A physical/preventive visit and a diagnostic care visit where you will be responsible to pay a co-pay/co-insurance or deductible.   The same also applies if you are coming to your doctor and the doctor performs a routine screening related to the visit that may have been covered as preventive if you had come in for a preventive visit.  The screen is part of your diagnostic care and as such you will be responsible for the co-pay/co-insurance deductible for that visit.   So regular preventive care can help you stay well, catch problems early on, save you money and may be potentially life-saving.

So what can you expect during a Preventive/Physical/Well-Visit?

The rules for what is considered a preventive visit or part of a preventive visit and what isn’t are set by the Center for Medicare and Medicaid Services and your Health Insurance company.   As your health care provider, we are required to submit accurate health records indicating the exact reason for your visit and everything that was done and discussed during your visit. Each concern is grouped into a visit code and a diagnostic code.  That is how the different topics and health concerns addressed at your visit are organized into “preventive” versus “diagnostic” care.   Any attempt to not accurately account for everything puts you at risk and undermines our ethical obligations.  With that said, there isn’t a set rule as to how a Physical is conducted. Each doctor or practice will develop its own method of gathering necessary information (basically the purpose of a Physical) to see what is your current state of health and well-being.

Generally you can expect all, some or a variation of the following (courtesy of WebMD):

History: This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about important behaviors, like smoking, excessive alcohol use, sexual health, diet, and exercise.  The doctor will also check on your vaccination status and update your personal and family medical history.

Vital Signs: These are some vital signs checked by your doctor:

·         Blood pressure: less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

·         Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.

·         Respiration rate: Around 16 is normal. Breathing more than 20 times per minute can suggest heart or lung problems.

·         Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

General Appearance: Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?

Heart Exam: Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.

Lung Exam: Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.

Head and Neck Exam: Opening up and saying "ah" shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries are also examined.

Abdominal Exam: Your doctor can use a range of examination techniques including tapping your abdomen to detect liver size and presence of abdominal fluid, listening for bowel sounds with a stethoscope, and palpating for tenderness.

Neurological Exam: Nerves, muscle strength, reflexes, balance, and mental state are assessed.

Dermatological Exam: Skin and nail findings could indicate a dermatological problem or disease somewhere else in the body.

Extremities Exam: Your doctor will look for physical and sensory changes. Pulses can be checked in your arms and legs. Examining joints can assess for abnormalities.

Male Physical Exam

An annual physical exam for men might also include:

• Testicular exam: A doctor can check each testicle for lumps, tenderness, or changes in size. Most men with testicular cancer notice a growth before seeing a doctor.
•  Hernia exam: The famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum.\
•  Penis exam: A doctor might notice evidence of sexually transmitted infections such as warts or ulcers on the penis.
•  Prostate exam: Inserting a finger in the rectum lets a doctor feel the prostate for its size and any suspicious areas.

Female Physical Exam

A woman's annual exam might include:

• Breast exam. Feeling for abnormal lumps may detect breast cancer or benign breast conditions. The doctor will also check the lymph nodes in the underarm area and look for visual abnormalities of the breasts.
• Pelvic exam: The pelvic exam allows examination of the vulva, vagina, and cervix. Routine checks for sexually transmitted infections are often done. A Pap test can screen for cervical cancer. 

Laboratory Tests

There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely:

• Complete blood count
• Chemistry panel
• Urinalysis (UA)

Unless symptoms already suggest a problem, these tests are unlikely to provide useful information.

A lipid panel (cholesterol test) is recommended every five years. Abnormal cholesterol levels increase the risk for heart attacksand strokes.

Physicals Should Emphasize Prevention

• At age 50, it's time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer may need to be screened before age 50.
• For most women, age 40 marks the time to begin annual mammogram screening for breast cancer.
• Everyone should have their cholesterol (lipids) checked every five years after age 20, according to the American Heart Association.

When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  Make the appointment when you truly are well so the visit can focus on verifying your health and helping you manage your good health.  Check with your insurance company which other services are considered “preventive” and thus have no co-pay/co-insurance or deductible.  For example, most insurance companies are now fully covering a variety of immunizations such as: Hepatitis A and B, Flu, Herpes Zoster, Pneumococcal and more.  All you have to do is come in specifically for and only for a covered vaccination and it’s totally free to you (your health insurance will be billed and your health insurance carrier will cover your co-pay, co-insurance and any deductible).  The best way for you to know which services your plan considers “preventive” and free to you is to call your insurance company and ask. Visit avecinia’s list of  health insurance companies it is contracted with to find your insurance company’s website/contact information.  Generally, the preventive services listed under the Affordable Care Act will be covered services.  Take advantage of this great opportunity to save money and save your life today!

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!