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Annual Physical - what does it include?

Annual Physical - what does it include?

Old Jan 13th 2019, 3:44 am
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Default Annual Physical - what does it include?

I've been seeing the same doctor for about 20 years. Every year, I have an annual physical. Basically, involves
  1. ECG (my g/f never had this so maybe this is not standard)
  2. Ear inspection (looking for wax, etc)
  3. Throat inspection ('say ahhh....')
  4. Knee jerk reaction (tap on knee with a small hammer)
  5. Groin inspection - cough while pressing hard
  6. Quick overall 'inspection' - looks at feet, legs, torso, etc.
  7. Listen to lung / heart operation ('take a deep breath...').
  8. Digital Rectal probe for Prostate (maybe this started as I got older)
  9. Followed by blood, Urine, and stool samples for lab analysis.
This year, since I'm resident in AZ for the year, I have to use a local doctor so found myself someone who was taking new patients. Basically, she did the following (compared to the list above):
  1. Listen to lung / heart operation ('take a deep breath...').
  2. Followed by blood ONLY (no urine, no stool samples).
Since I've just turned 60, and since I'm paying $9,000 in premiums, I'm a bit miffed that this is all she did. I'm going to pursue the matter further with her (I thought I was going to see her again during the visit but I discovered that 'she was done' already so I lost my chance to discuss with her at the time).

Anyway - is there any sort of 'standard' as to what should be done (for a 60 year old male, for example)? It never occurred to me to question this since my old doc just did this every single year forever!
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Old Jan 13th 2019, 6:26 am
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Default Re: Annual Physical - what does it include?

When I was in the US there was no standard in my experience, some doctors did everything under the sun, others did very little beyond asking a few questions, I only went to them as I got a discount on my monthly premium if I had one done.

Since moving to Canada, I haven't had one since annual physicals are not medically necessary and not covered.
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Old Jan 13th 2019, 1:54 pm
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Default Re: Annual Physical - what does it include?

Hi Steerpike,

As you know I'm in AZ, just turned 59, and I've also been seeing my doctor for about 20 years. My yearly "well woman" exam is similar to your first longer list (minus the ECG and groin, plus the pap test if needed). The labs are only bloodwork, no urine or stool samples. And of course my yearly mammogram.

On the other hand, I have a female friend who just turned 56, is in great health, and her doctor does all kinds of tests and exams (EKG, stress test, bone density I think, just a bunch of things that I've never had done in my life). She and I were just discussing this the other day. I said I'm not sure if this means your doctor is just more thorough than mine, or if she thinks you have medical issues, if my doctor doesn't care....who knows.

So it seems pretty random.

Rene
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Old Jan 13th 2019, 2:18 pm
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Default Re: Annual Physical - what does it include?

My annual physical was always the same as yours. Since I went on Medicare and moved to MS, I've not had a cardiogram and I finally broached the subject with my doctor. He said Medicare will not pay for it unless there is a health issue that warrants it. This ticks me off as I feel that the older you are the more you need to have your heart and arteries checked yearly. Also Medicare will not pay for a pap test for a woman annually but only once every two years. My mother had cervical cancer and still it is not allowed. Instead, I have them bill the combo card and my private supplement picks up part of it and so far the doctor will accept that as payment in full.

Thankfully, I can get the mammogram and the bone density test without a problem. The bone density is not yearly but I believe once every three years.
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Old Jan 13th 2019, 2:32 pm
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Default Re: Annual Physical - what does it include?

Cardiovascular and blood.
It seems the blood analysis gives a ton of information on other things anyway.
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Old Jan 13th 2019, 2:55 pm
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Default Re: Annual Physical - what does it include?

More or less as per your long list, but no ECG, and no urine or stool test.

​​​​​​​The conversation during the exam usually seems to reflect surprise that everything is working normally, and that everything measures in normal range on my blood test, despite the entire lack of long term prescriptions or medical interventions.

​​​​​​​I am also usually told lose a few pounds, which is a fair, though only with an emphasis on "few". Part of my problem that the weight charts are a linear extrapolation of someone who is 5'8" and the further you get from that height the more unrealistic the weight expectation becomes (fair weight increases as a function of volume, not height - think mouse v elephant).

​​​​​​​All that said, the services provided are almost certainly a function of what your insurance pays for, so may differ from person to person even seeing the same doctor.

Last edited by Pulaski; Jan 13th 2019 at 3:11 pm.
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Old Jan 13th 2019, 3:01 pm
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Default Re: Annual Physical - what does it include?

Originally Posted by Steerpike
I've been seeing the same doctor for about 20 years. Every year, I have an annual physical. Basically, involves
  1. ECG (my g/f never had this so maybe this is not standard)
  2. Ear inspection (looking for wax, etc)
  3. Throat inspection ('say ahhh....')
  4. Knee jerk reaction (tap on knee with a small hammer)
  5. Groin inspection - cough while pressing hard
  6. Quick overall 'inspection' - looks at feet, legs, torso, etc.
  7. Listen to lung / heart operation ('take a deep breath...').
  8. Digital Rectal probe for Prostate (maybe this started as I got older)
  9. Followed by blood, Urine, and stool samples for lab analysis.
This year, since I'm resident in AZ for the year, I have to use a local doctor so found myself someone who was taking new patients. Basically, she did the following (compared to the list above):
  1. Listen to lung / heart operation ('take a deep breath...').
  2. Followed by blood ONLY (no urine, no stool samples).
Since I've just turned 60, and since I'm paying $9,000 in premiums, I'm a bit miffed that this is all she did. I'm going to pursue the matter further with her (I thought I was going to see her again during the visit but I discovered that 'she was done' already so I lost my chance to discuss with her at the time).

Anyway - is there any sort of 'standard' as to what should be done (for a 60 year old male, for example)? It never occurred to me to question this since my old doc just did this every single year forever!
I know your premium is high but does it include a yearly physical with no co - pay? If it does the physicals can vary as to what is "free" and what isn't. You can have what you want if you pay extra!
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Old Jan 13th 2019, 3:13 pm
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Default Re: Annual Physical - what does it include?

Originally Posted by Sugarmooma
I know your premium is high but does it include a yearly physical with no co - pay? ....
​​​​​​​I thought that was an ACA/ Healthcare Reform requirement?
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Old Jan 13th 2019, 3:58 pm
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Default Re: Annual Physical - what does it include?

Originally Posted by Pulaski
I thought that was an ACA/ Healthcare Reform requirement?
Yes, the thrust of this question is, what is considered 'standard' for an ACA-compliant plan (for a 60-year old male), which includes an annual physical.

I'm surprised that the males on this thread are not getting the stool sample check; I thought that was another way to check for prostate issues, which is supposedly a huge killer for men in their later years. In my own case, I'm most surprised that the doc didn't do the 'digital rectal probe' for prostate ("finger up the bum"). This is supposedly the easiest, cheapest way to catch prostate issues.

In all honesty, I've always had very good insurance in the past (employer provided) and also been making good income (and have good health) so I didn't pay too much attention to medical bills - just paid them; there's a decent chance that I was getting billed for some of this and just didn't care. Now I'm semi-retired (MUCH less income), and have crappier insurance, I'm finally paying more attention!
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Old Jan 13th 2019, 4:25 pm
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Default Re: Annual Physical - what does it include?

Originally Posted by Pulaski
I thought that was an ACA/ Healthcare Reform requirement?
It is. But what I'm getting at is a physical is a very lose term as to what is included.

For example, some insurance policies will say they cover well baby check ups 4 times a year in the first 2 years. You can have a policy that just covers the doctors check up, ( weight, height, head circumference, respiration and temperature ) but not the immunizations necessary at that age. Then you can have a different policy that covers it all.

​​​​​​​So defining a " physical" that is covered in your policy might not be what you are used to. And as I said, if you want more then you pay extra.
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Old Jan 13th 2019, 4:27 pm
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Default Re: Annual Physical - what does it include?

Originally Posted by Steerpike
Yes, the thrust of this question is, what is considered 'standard' for an ACA-compliant plan (for a 60-year old male), which includes an annual physical.

I'm surprised that the males on this thread are not getting the stool sample check; I thought that was another way to check for prostate issues, which is supposedly a huge killer for men in their later years. In my own case, I'm most surprised that the doc didn't do the 'digital rectal probe' for prostate ("finger up the bum"). This is supposedly the easiest, cheapest way to catch prostate issues. ....
​​​​​​​I think I see the reason for some of the differences, and your questions - there are "standard" tests, that aren't typically performed every year, such as FUB.

​​​​​​​I hear that while it is usually considered "necessary" to have a colonoscopy when you reach fifty, it is not now repeated after five years if the first one was clean; the repeat is only recommended after ten years.

​​​​​​​I think that some of the routine screenings for women have also had changes to the recommended age and frequencies, in the UK at least, if not the US.

Last edited by Pulaski; Jan 13th 2019 at 4:42 pm.
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Old Jan 13th 2019, 4:29 pm
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Default Re: Annual Physical - what does it include?

I believe the ACA mandates a physical exam as a covered benefit without copayment for any insurance (with caveats for these non-compliant short term plans and Medicare (?)).

A couple of recent studies have shown no improvement to health outcomes from a yearly exam. I still go yearly (in fact, in ten days...) but I wonder whether I would if I had to pay for it.

Is an Annual Physical Exam Really Necessary? Time
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Old Jan 13th 2019, 4:49 pm
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Default Re: Annual Physical - what does it include?

I have heard if at least one such study, with results that sound counterintuitive, but makes total sense if you think about the numbers: I for disease x (the one I read about was breast cancer), life expectancy is three years if found without annual screening, but five years if there is an annual screening program in place, and if screening finds the signs of disease two years earlier than without screening, then the screening program has no impact on life expectancy, but subjects women (99%of the time) to two years of unpleasant and/or invasive treatments which might have no likelihood of increased life expectancy.
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Old Jan 13th 2019, 5:38 pm
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Default Re: Annual Physical - what does it include?

In Colorado they have 9 News Health Fairs, I occasionally go, you get the basics done for a reasonable fee.

My Brother actually had his annual in the UK recently, I did not know there was such a thing, I will ask him how comprehensive it was. Now he seems to have more medical issues than me, maybe I will just get the big one.

I have also come across discussions in the past Mr P mentioned that some of this stuff is not simple, also begs the question if you would want to know if you had something that there was not a lot you could do about, I know I am going to die, when and how well not sure I want to know.

To carry on the depressing subject an article in WaPo regarding Insulin. https://www.washingtonpost.com/news/...=.448e0681f8af

Difficult one, so many issues, the one thing is that is obvious is that some things that were once expensive are much cheaper, the Laptop I am typing on, the Petrol I last bought, other things have got a lot more expensive for a whole variety of reasons, Medical stuff being the classic example.

Think I will go walk the dog.
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Old Jan 13th 2019, 6:38 pm
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Default Re: Annual Physical - what does it include?

Crazy how different healthcare systems view annual physicals, they still seem very common in the US it seems based on the replies here.
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