There have been a number of articles recently that explore the value of getting a physical each year to screen for potential health problems. We talked with a member of our Medical Advisory Board, George H. Sack, MD, PhD, to discuss the topic. Dr. Sack, who is board certified in Medical Genetics, is currently the Medical Director of Johns Hopkins USA, a concierge service for out-of-state patients who need help navigating the Johns Hopkins Medical System. He was formerly the Director of Hopkins’ Executive Health Program. He is also an Associate Professor of Medicine and Biological Chemistry at Johns Hopkins University School of Medicine in Maryland, as well as an active researcher in the field of genetics.
Q: Do people need to get an annual physical as part of their preventive care strategy?
George H. Sack, MD, PhD (GS): To answer that question, I’d like to back up a little. There’s a difference in the value of establishing a comprehensive baseline and an individual’s going to the doctor every year for a physical examination. If you don’t have a baseline, you don’t know, for example, whether an individual’s cholesterol level has gone up and requires treatment. I’ve seen many patients who are 50 and when I ask them when the last time they saw a doctor was, their answer is when they were in college! No one can find a health problem if no one looks for it, so that’s why it’s important to have a comprehensive examination so that you can catch health problems and have information to compare with future test results. The value of a follow-up exam is incredibly dependent on having baseline data.
I did a research project that asked the question, “Is an annual physical worth the effort and cost?” I looked at 500 consecutive new patients who came to me for a comprehensive executive physical during an 18-month period. None of them had symptoms of any disease and they all believed they were in good health. I followed the same protocol for all of them, ordering the same tests. What I found was that one-third of the people in the study left my office with a new diagnosis of some health problem that could be treated, from high blood pressure to cancer.
Q: What are the elements that should be included in an appointment to establish a patient’s baseline?
GS: Your doctor should do a complete history and physical, which takes a good hour. As part of the exam, you should have an electrocardiogram, an eye exam to check for glaucoma, and a set of basic blood studies. For patients who have a history of smoking, I’d also include a chest CT to screen for lung cancer.
Q: Should genetic sequencing and biomarker testing be part of the information in your baseline?
GS: In a decade, gene sequencing will be standard, but right now, most physicians are not trained to interpret this information. Biomarker testing isn’t at the point yet where the data that can be gathered has a direct relationship with an underlying pathologic, biological event like a heart attack or hypertension. We’re still missing a piece because we just don’t understand the biology well enough.
Q: At what age should you have your baseline evaluation?
GS: If you don’t have a family history of health problems like diabetes or high blood pressure, you can get your comprehensive baseline exam at around age 40. If, however, your father died of a heart attack at 38, you should see your doctor in your early 30s. You need to take a personalized approach based on your individual risk factors and family history.
Q: After you establish a baseline, do you need an annual physical to follow up?
GS: If the exam finds a health problem, then you most likely need annual visits to manage the issue. If, however, no problems are uncovered, then you can probably wait 2 or 3 years before your next visit. However, if you’re 70 or older, the data support getting an annual physical. Health issues start to arise more frequently and quickly then, so it’s important to have the opportunity to catch and treat them as early as possible.
Learn how a health advisor can help you assess your health needs and schedule appropriate screenings to establish your comprehensive baseline and build a personalized health strategy.