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I do not use annual visits for disease management but rather health promotion.
The evidence to support an annual physical exam for most adults is weak.Some argue that this ritualistic visit uses medical resources unnecessarily. Most adults today over age 50 have one or more chronic health problems so a visit to evaluate those makes sense. Most often we spend our time doing “chronic disease management” refilling prescriptions and ordering lab work. Patients do not usually become healthier. This common behavior is a missed opportunity.
I do not use annual visits for disease management but rather health promotion. Most chronic diseases, which cost the great majority of health care dollars, are considered “Western diseases” due to the Western diet and lifestyle. Most of these diseases can be reversed and the annual exam is an ideal opportunity to do this disease reversal work.
When I do a health check up on any patient I ask about their health goals from a biopsychosocial framework. I also perform a body composition using the InBody technology. This gives me the patient’s body fat mass and percentage, the skeletal muscle mass and the BMI. The printed result that every patient gets shows their body composition compared with optimal ranges.I consider the body composition the most helpful “vital sign.”
Most adults have excess body fat in their abdomen and that drives the metabolic dysfunctions of insulin resistance. Reversing insulin resistance is straightforward with a low carbohydrate healthy food diet and time restricted eating. Adopting this nutrition plan for life can reverse several common health problems, including overweight and obesity, prediabetes and type 2 diabetes, hypertension and hyperlipidemia and fatty liver disease.
Many adults have inadequate skeletal muscle. By prescribing activities for movement, strength and balance, patients improve their fitness. The InBody body composition has a memory of each patient so trends can be seen over time. While the health and financial value of this effort has not been well documented, the value of a healthier body with less abdominal fat are obvious.Blood pressure, glucose and lipids are dramatically improved.
Within the time allowed for an annual exam the physician can help patients become healthier and become a true healer. The joy of this effort will go a long way at increasing practice satisfaction and avoiding burnout.
Joseph E. Scherger, M.D., M.P.H., is a family physician at Eisenhower Health in La Quinta, California, and is a member of the Medical Economics® editorial advisory board. He is also a core faculty member with the Eisenhower Health Family Medicine Residency Program. Dr. Scherger is clinical professor of family medicine at the Keck School of Medicine at the University of Southern California (USC), and is a leader in transforming office practice.