MD & DO How do you perform an "adult wellness" evaluation (aka an "annual physical")?

[cbrons]

Did you ever ask yourself:

* What information am I supposed to gather when I'm assigned to do a "physical" on a patient?
* What cancer screening tests are important in each age group?
* What lab tests do you run in healthy people during their so-called "annual physical"?
* Who needs to be screening regularly for diabetes and how often?
* Who needs to be screened regularly for STDs and how often (and with what specific tests)?
* What should I be recommending to patients for primary prevention?
* Who needs to be taking aspirin for primary prevention?

If you've wondered these things, then see the .pdf attached to this thread. It's something I worked on over the course of several months while several medicine sub-internships during my M4 year.

Of course, I would love if anyone has any clarifications or corrections to submit. That is part of the reason I'm posting this here.

Here is the preoperative history and physical thread.

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Updated 7-1-2017

• Corrected STD screening indications
• Updated indications for dyslipidemia screening based on AACE 2017 recommendations, starting fasting lipid screening for dyslipidemia in persons 20 years old then every 5 years thereafter.

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[Rekt]

Did you ever ask yourself:

* What information am I supposed to gather when I'm assigned to do a "physical" on a patient?
* What cancer screening tests are important in each age group?
* What lab tests do you run in healthy people during their so-called "annual physical"?
* Who needs to be screening regularly for diabetes and how often?
* Who needs to be screened regularly for STDs and how often (and with what specific tests)?
* What should I be recommending to patients for primary prevention?
* Who needs to be taking aspirin for primary prevention?

If you've wondered these things, then see the .pdf attached to this thread. It's something I worked on over the course of several months while several medicine sub-internships during my M4 year.

Of course, I would love if anyone has any clarifications or corrections to submit. That is part of the reason I'm posting this here.

Here is the preoperative clearance evaluation.

This looks pretty good, thanks.

 

[acapnial]

Did you ever ask yourself:

* What information am I supposed to gather when I'm assigned to do a "physical" on a patient?
* What cancer screening tests are important in each age group?
* What lab tests do you run in healthy people during their so-called "annual physical"?
* Who needs to be screening regularly for diabetes and how often?
* Who needs to be screened regularly for STDs and how often (and with what specific tests)?
* What should I be recommending to patients for primary prevention?
* Who needs to be taking aspirin for primary prevention?

If you've wondered these things, then see the .pdf attached to this thread. It's something I worked on over the course of several months while several medicine sub-internships during my M4 year.

Of course, I would love if anyone has any clarifications or corrections to submit. That is part of the reason I'm posting this here.

Here is the preoperative clearance evaluation.

Good stuff, well organized. Only thing I saw was that pap smears were listed for 18+, but ACOG and USPSTF both recommend starting at 21.

 

[cbrons]

Good stuff, well organized. Only thing I saw was that pap smears were listed for 18+, but ACOG and USPSTF both recommend starting at 21.

I think it more depends on when they begin sexual activity.

I'd also like to ask physicians like what they think about this document, if they have time. I think it could be helpful for new M3s on Family medicine or outpatient IM.

@VA Hopeful Dr @Blue Dog

 

[Lawpy]

Good stuff! Hopefully you are able to post more of these soon.

 

[acapnial]

I think it more depends on when they begin sexual activity.

I'd also like to ask physicians like what they think about this document, if they have time. I think it could be helpful for new M3s on Family medicine or outpatient IM.

@VA Hopeful Dr @Blue Dog

Ye olde guidelines recommended paps at either 21 or initiation of sexual activity, but the current guidelines recommend beginning at 21 regardless of when people start having sex.

FP and ob/gyn docs in the community can ignore the guidelines if they want, but if a shelf exam asks you if a sexually active 19 year old needs a pap smear there is a very clear right and wrong answer.

 

[cbrons]

Ye olde guidelines recommended paps at either 21 or initiation of sexual activity, but the current guidelines recommend beginning at 21 regardless of when people start having sex.

FP and ob/gyn docs in the community can ignore the guidelines if they want, but if a shelf exam asks you if a sexually active 19 year old needs a pap smear there is a very clear right and wrong answer.

I checked up on this and you are correct. I updated the document and put in the ACOG guidelines. It is now in the OP for download.

 

[VA Hopeful Dr]

Ye olde guidelines recommended paps at either 21 or initiation of sexual activity, but the current guidelines recommend beginning at 21 regardless of when people start having sex.

FP and ob/gyn docs in the community can ignore the guidelines if they want, but if a shelf exam asks you if a sexually active 19 year old needs a pap smear there is a very clear right and wrong answer.

Correct, the answer is age 21.

 

[WheezyBaby]

Believe low resolution CT for lung cancer should be annually

 

[cbrons]

Believe low resolution CT for lung cancer should be annually

You are right, I fixed it. THank you

 

[cellsaver]

You are right, I fixed it. THank you

You just graduated with an MD Degree! Congratulations!

Your humility and passion for helping others will be very powerful instruments. May we be blessed with many more physicians like you.

Godspeed

 

[neoevolution]

My FM rotation site distinguished between "Annual Wellness Visit" and "Physical" based on patient insurance. AWV had more screening questions and physical emphasized the exam more. Is that the norm?

 

[oldanddone]

Preventive Care Checklist Forms. | Resources | Resources | The College of Family Physicians Canada

This is a Canadian guide so may need u.s. guideline translation however could be useful resource.

 

[oldanddone]

Practice Guidelines: Introduction to AAFP Summary of Recommendations for Periodic Health Examinations - American Family Physician

Aafp has great articles. This one is 2002 they likely have updated summary. On their site is a collection of practice guidelines for fp as well

 

[VA Hopeful Dr]

My FM rotation site distinguished between "Annual Wellness Visit" and "Physical" based on patient insurance. AWV had more screening questions and physical emphasized the exam more. Is that the norm?

Pretty much, although the evidence behind a yearly physical is pretty bad so most of us are moving away from it.

 

[Goro]

Did you ever ask yourself:

* What information am I supposed to gather when I'm assigned to do a "physical" on a patient?
* What cancer screening tests are important in each age group?
* What lab tests do you run in healthy people during their so-called "annual physical"?
* Who needs to be screening regularly for diabetes and how often?
* Who needs to be screened regularly for STDs and how often (and with what specific tests)?
* What should I be recommending to patients for primary prevention?
* Who needs to be taking aspirin for primary prevention?

If you've wondered these things, then see the .pdf attached to this thread. It's something I worked on over the course of several months while several medicine sub-internships during my M4 year.

Of course, I would love if anyone has any clarifications or corrections to submit. That is part of the reason I'm posting this here.

Here is the preoperative clearance evaluation.

Screen for depression?

 

[cbrons]

Did you ever ask yourself:

* What information am I supposed to gather when I'm assigned to do a "physical" on a patient?
* What cancer screening tests are important in each age group?
* What lab tests do you run in healthy people during their so-called "annual physical"?
* Who needs to be screening regularly for diabetes and how often?
* Who needs to be screened regularly for STDs and how often (and with what specific tests)?
* What should I be recommending to patients for primary prevention?
* Who needs to be taking aspirin for primary prevention?

If you've wondered these things, then see the .pdf attached to this thread. It's something I worked on over the course of several months while several medicine sub-internships during my M4 year.

Of course, I would love if anyone has any clarifications or corrections to submit. That is part of the reason I'm posting this here.

Here is the preoperative history and physical thread.

I just uploaded the recent version.

 

[cbrons]

Screen for depression?

The PHQ-2 is in there

 

[neoevolution]

When guidelines contradict, which ones does the NBME look for? I have FM clerkship exam coming up and was told to go off of USPSTF?

 

[ACLPCL]

Are there any efficient and comprehensive templates (oxymoron I know) for Medicare Annual Wellness Visits or Advanced Care Planning that anyone has come across and would be willing to share?

 

[VA Hopeful Dr]

If only there were something that would enable a person to search for information across a large amount of information with ease. Maybe called some weird word that 10 years after its inception becomes part of the language.

Oh well.

Log in -- Family Practice Management

 

[ACLPCL]

Thanks for the sarcasm.

I'm aware of that one but wanted to see if anyone had come across something better, as well as an HRA tool.