Patients presenting for Routine Screening

Things that are covered include the past medical and surgical history, list of all medications, including OTC drugs and herbal supplements, current symptoms, if any, questions the patient has about health-related topics, vaccinations, and screening tests. Information from specialists should be gathered so as to have a complete picture of the care the patient is receiving from all providers. Chronic diseases are discussed and managed during this examination.

In the history, the past medical history is covered, including past surgeries and allergies. Lifestyle questions are asked about, such as smoking history, exercise, dietary habits, alcohol and drug use, and safety issues in the home. Medications taken are part of the history as well.

The examination is relatively thorough, with a dermatological evaluation, heart and lung exam, abdominal examination, genitourinary examination, and evaluation of muscle strength, gross neurological functioning, and gait. Vital signs are done to check for hypertension and rhythm abnormalities.

After the examination, immunizations are given. Immunizations are given to adults as well as children. Labs are done for screening purposes and to follow up for chronic illnesses. Things like mammography, PAP tests, and colonoscopies are done during the annual examination or ordered for a later date. If there are findings on any of the tests, these may need to be discussed with the patient at a later time, particularly if something needs to be done.

PATIENTS PRESENTING FOR ROUTINE SCREENING

Routine screening is done at every stage of life. In the young patient above the age of 18 years and up to about 27 years, the patient should have several screening examinations. There is no mammography or colorectal screening in the average-risk patient at this age but cervical cancer screening is done every three years, starting at age 21 and ending at age 65 years. Cytology with HPV testing is done every five years between 30 and 65 years of age. Skin cancer screening is done at the provider’s discretion.

Eye examinations are done annually on all diabetic patients but a hearing examination is not done if there are no symptoms. Zika virus screening is done for high-risk female

patients who are of reproductive age. All sexually active women under 25 years are screened for chlamydia and gonorrhea. Older persons are assessed for these STDs if they have high-risk sexual behaviors. Syphilis screening is done on all pregnant women. HIV screening is done on pregnant women and annually on high-risk patients.

The immunization done every year is the influenza vaccination, which is done because the virus changes continually. The tetanus and diphtheria vaccines are given together every ten years. Pneumococcus is given in two doses and MMR is given for those born after 1957 or do not have documented vaccinations in the past. Two doses of the Varicella vaccine are given if there has been no immunity. Meningococcus is given once or twice, plus a booster every 5 years if there is a risk. The Herpes zoster shot is not given in young people. Young people under 27 are given up to 3 doses of the HPV examination and those that never had hepatitis B vaccinations as children should receive 3 doses. Hepatitis A is only done if the person is high risk. Haemophilus influenzae vaccination is given to those with sickle cell anemia, asplenia, or those who’ve had a stem cell transplant.

All patients should have their body mass index done annually. The lipid screen is done on adults older than 18 years but generally isn’t done every year. The blood pressure evaluation is done every visit and should be done in every patient every other year.

The middle-aged adult should also have a well visit every one to three years, regardless of their risk factors. There are some screening tests that need to be done. There is generally no cancer screening for colorectal cancer, skin cancer, or breast cancer unless the person reaches a certain age. For example, colorectal screening starts at age 45 years for African-Americans and mammograms are started after age 50 after discussing risks and benefits. Cervical cancer screening is the same as for younger people. Testicular and prostate cancer screening starts at age 40 with a PSA examination but stops at age 70 years.

Vision screening is done every 2 to 4 years in middle age, while people of African descent have glaucoma screening every 2 years after age 40. Hearing testing is not done if there are no symptoms. Immunizations are the same as for young people with annual influenza shots and tetanus-diphtheria every 10 years.