The Slim Book of Health Pearls: The Complete Medical Examination. Sheldon Cohen M.D. M.D.
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THE SLIM BOOK OF HEALTH PEARLS:
THE PATIENT’S GUIDE
TO
THE COMPLETE MEDICAL EXAMINATION
SHELDON COHEN M.D. FACP
“All things are to be examined and called into question.
There are no limits set to thought.”
Edith Hamilton
1867-1963
Copyright 2012 Sheldon Cohen,
All rights reserved.
Published in eBook format by eBookIt.com
ISBN-13: 978-1-4566-0749-4
No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems, without permission in writing from the author. The only exception is by a reviewer, who may quote short excerpts in a review.
The information, ideas, and suggestions in this book are not intended as a substitute for professional medical advice. Before following any suggestions contained in this book, you must consult your personal physician. The publisher or the author shall not be liable or responsible for any loss or damage allegedly arising as a consequence of your use or application of any information or suggestions in this book.
CHAPTER 1
Introduction
A complete medical examination includes a:
Medical history
Physical examination
Basic laboratory data
Risk factor analysis
Patients who have a good grasp of their personal medical data can prevent becoming a medical error statistic.
This book is for patients who want to take charge of their health and for members of the health professions interested in a review of the basics.
The book will speak to the patient and attempt to answer the questions asked over the years as the health care provider (physician, nurse, physician assistant) gathers a medical history and performs the physical examination. Patients need to know why the examiner asks specific questions, what benefits accrue from a thorough medical history, complete physical examination and, risk factor analysis, how the data is put together to arrive at the correct diagnose; and how this information will enable the prevention of medical errors.
The point needs repeating: involving the patient is the latest emphasis in the ongoing battle to prevent the medical errors that affect patients and healthcare workers alike. Being an educated patient is the best defense. When patients have a good grasp of their health problems, they become an important member of the team whose goal is to provide optimal and safe care.
Granted, this may all take time and presumes an ambulatory patient with the time to spend evaluating options. However, the time needed may not be available if the patient is involved in an acute life and death medical or surgical situation and is in an unfamiliar medical environment. In this instance, a written, or otherwise instantly retrievable summary of the medical history may be life saving. This is one reason why there is such a national impetus to promote electronic medical records, but until this day arrives, healthcare professionals must provide their patients with this important data in writing and not assume that when patients are told medical facts they will remembered for all time. Patients may soon forget what they learned in their doctor’s office.
In the absence of this critical, instantly retrievable medical information, and if a patient is unable to provide good clinical information, physicians, who are seeing a patient for the first time, will not be well-prepared for the very difficult and responsible position of having to provide care.
The book will discuss the important first step to take in health evaluation: a complete medical examination. Those educated to perform this vital examination include all physicians; but many super specialists, concentrating on their small slice of the body get rusty. Therefore, the responsibility falls to primary care physicians defined as internal medicine, pediatrics and family practice, and also a nurse and physician assistant.
The author will use the word “physician” when writing about the professional who captures a medical history and performs a physical examination. More often than not, the word physician will mean a doctor of medicine, either an M.D. or D.O., and, also in this case, a nurse and physician assistant.
Physicians first learn how to evaluate a patient in their early years of medical school. By the time budding physicians have graduated, they have had experience in taking medical histories and examining patients under close senior physician supervision. At this point, medical students have learned how to learn, and only a continuing experience will allow them to polish their craft. Nurses can receive master’s degree specialized education in the performance of the complete medical examination, and physician assistants can be educated to perform this function as well.
In the 1920’s the Metropolitan Life Insurance Company demonstrated that policyholders who underwent annual complete medical examinations lived longer than those who did not. On the strength of these statistics, the American Medical Association recommended periodic examinations of all healthy persons starting at age thirty-five. The general patient population has not yet received the benefit of this recommendation. Corporate executives have utilized the concept often, but the average person has failed to get a complete medical examination in any great numbers. What is the reason for this?
The most important physician-patient interaction occurs at the initial visit when patients present for a complete medical evaluation. This is time consuming and expensive. It stands to reason that a well taken medical history and full head-to-toe physical examination has a better chance of uncovering medical problems than an examination done in a hurried and cursory manner. However, the complaint I continue to hear from patients is that “The doctor had one foot in the door and one foot out.” As already mentioned, the average physician is very busy with acute and follow-up care, so they schedule their time to take care of the many patients seeking help. Therefore, the complete medical evaluation has suffered—and we are paying the price in unhappy patients, overworked physicians, medical errors and a malpractice crisis.
There are those who argue against the periodic complete medical examination, saying that it may not be cost effective in terms of the yield. They propose that the evaluation of patients who have no symptoms should be selective and based upon the age and sex of the patient. Major medical organizations in the United States and Canada have endorsed this approach. Most physicians do not dispute the wisdom of these endorsements, but cling to the belief that the complete medical examination is important, even though they bemoan the time constraints that make it difficult, and they cite the following reasons:
(1) Patients expect a complete medical examination.
(2) Physicians have had numerous experiences where the performance of the complete medical examination has elicited unexpected critical findings.
(3) A well-done