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词条 General medical examination
释义

  1. Evidence

  2. Prevalence

  3. History

  4. References

  5. External links

The general medical examination is a common form of preventive medicine involving visits to a general practitioner by well feeling adults on a regular basis. This examination is done generally yearly or less frequently. It is known under various non-specific names, such as the periodic health evaluation, annual physical, comprehensive medical exam, general health check, preventive health examination, medical check-up, or simply medical. If done for a group of people it is a form of screening, as the aim of the examination is to detect early signs of diseases to prevent them[1].

In the United Kingdom, the examination remains unpopular with the general populace.[2][3]

The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer, or regular visits for people with certain chronic medical disorders (for example, diabetes).[4] The general medical examination generally involves a medical history, a (brief or complete) physical examination and sometimes laboratory tests. Some more advanced tests include ultrasound and mammography.

If necessary, the patient may be sent to a medical specialist for further, more detailed examinations.

Evidence

Although annual medical examinations are a routine practice in several countries, unspecified examinations are poorly supported by scientific evidence in the majority of the population. A 2012 Cochrane review did not find any benefit with respect to the risk of death or poor outcomes related to disease in those who received them.[3]{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/30699470|date = March 2019}} People who undergo yearly medical exams however are more likely to be diagnosed with medical problems.[3]

Some notable general health organisations recommend against annual examinations, and propose a frequency adpated to age and previous exmination results (risk factors).[4][5][6] The specialist American Cancer Society recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20.[7]

A systematic review of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol screening, and faecal occult blood tests) and less patient worry.[8] Evidence supports several of these individual screening interventions.[9][10][11] The effects of annual check-ups on overall costs, patient disability and mortality, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive.[8] A recent study found that the examination is associated with increased participation in cancer screening.[12]

The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge.[13] Despite guidelines recommending against routine annual examinations, many family physicians perform them.[14] A fee-for-service healthcare system has been suggested to promote this practice.[19] An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient.[5][15][16] This means choosing between a wide variety of tests.[17]

Most surgeons ask patients about recent general medical examination results in order to proceed with surgery [1] even though there are arguments for and against most screening interventions. Advantages include detection and subsequent prevention or early treatment of conditions such as high blood pressure, alcohol abuse, smoking, unhealthy diet, obesity and cancers. Moreover, they could improve the patient-physician relationship and decrease patient anxiety. More and more private insurance companies and even Medicare include annual physicals in their coverage.

Some employers require mandatory health checkup before hiring a candidate even though it is now well known that some of the components of the prophylactic annual visit may actually cause harm. For example, lab tests and exams that are performed on healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be “false positives” — that is, when test results suggest a problem that doesn’t exist.[18] Disadvantages cited include the time and money that could be saved by targeted screening (health economics argument),[19] increased anxiety over health risks (medicalisation), overdiagnosis, wrong diagnosis (for example Athletic heart syndrome misdiagnosed as Hypertrophic cardiomyopathy) and harm, or even death, resulting from unnecessary testing to detect or confirm, often non-existent, medical problems or while performing routine procedures as a followup after screening.[20][21][22]

Prevalence

It is commonly performed in the United States and Japan, whereas the practice varies among South East Asia and mainland European countries. In Japan it is required by law for regular working employees to check once a year, with a much more thorough battery of tests than other countries.

History

The roots of the periodic medical examination are not entirely clear. They seem to have been advocated since the 1920s.[23] Some authors point to pleads from the 19th and early 20th century for the early detection of diseases like tuberculosis, and periodic school health examinations.[24] The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine.[25][24][26][27][28] Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.[8][29][30]

References

1. ^{{cite book |first1=Angela E. |last1=Raffle |first2=J. A. |last2=Muir Gray |year=2007 |title=Screening: Evidence and practice |publisher=Oxford University Press |isbn=978-0-19-921449-5 |doi=10.1093/acprof:oso/9780199214495.001.0001}}
2. ^{{cite journal|last=Si|first=S|author2=Moss, JR |author3=Sullivan, TR |author4=Newton, SS |author5= Stocks, NP |title=Effectiveness of general practice-based health checks: a systematic review and meta-analysis.|journal=The British Journal of General Practice|date=Jan 2014|volume=64|issue=618|pages=e47–53|pmid=24567582|doi=10.3399/bjgp14x676456|pmc=3876170}}
3. ^1 2 {{cite journal|title=General health checks in adults for reducing morbidity and mortality from disease|journal=Cochrane Database of Systematic Reviews|volume=10|pages=CD009009|date=Oct 17, 2012|doi=10.1002/14651858.CD009009.pub2|pmid=23076952|last1=Krogsbøll|first1=Lasse T.|last2=Jørgensen|first2=Karsten Juhl|last3=Grønhøj Larsen|first3=Christian|last4=Gøtzsche|first4=Peter C.}}
4. ^US Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the Preventive Services Task Force 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
5. ^1 {{cite journal |title=Periodic health examination: a guide for designing individualized preventive health care in the asymptomatic patients. Medical Practice Committee, American College of Physicians |journal=Ann. Intern. Med. |volume=95 |issue=6 |pages=729–32 |date=December 1981 |pmid=7305155 |doi= 10.7326/0003-4819-95-6-729|url=}}
6. ^{{cite journal |vauthors=Hayward RS, Steinberg EP, Ford DE, Roizen MF, Roach KW |title=Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force |journal=Ann. Intern. Med. |volume=114 |issue=9 |pages=758–83 |date=May 1991 |pmid=2012359 |doi=10.7326/0003-4819-114-9-758}}
7. ^{{cite journal |vauthors=Mettlin C, Dodd GD |title=The American Cancer Society Guidelines for the cancer-related checkup: an update |journal=CA Cancer J Clin |volume=41 |issue=5 |pages=279–82 |year=1991 |pmid=1878784 |doi= 10.3322/canjclin.41.5.279}}
8. ^1 2 3 {{cite journal |vauthors=Boulware LE, Marinopoulos S, Phillips KA, etal |title=Systematic review: the value of the periodic health evaluation |journal=Ann. Intern. Med. |volume=146 |issue=4 |pages=289–300 |date=February 2007 |pmid=17310053 |doi= 10.7326/0003-4819-146-4-200702200-00008|url=}}
9. ^Screening for Lipid Disorders in Adults, Topic Page. June 2008. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspschol.htm
10. ^Screening for Colorectal Cancer, Topic Page. July 2002. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm
11. ^Screening for Cervical Cancer, Topic Page. January 2003. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm
12. ^{{cite journal|vauthors=Fenton JJ, Cai Y, Weiss NS, etal |title=Delivery of cancer screening: how important is the preventive health examination? |journal=Arch. Intern. Med. |volume=167 |issue=6 |pages=580–5 |date=March 2007 |pmid=17389289 |doi=10.1001/archinte.167.6.580 |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=17389289 |pmc=3443471 }}{{dead link|date=January 2017 |bot=InternetArchiveBot |fix-attempted=yes }}
13. ^{{cite journal |vauthors=Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ |title=Public expectations and attitudes for annual physical examinations and testing |journal=Ann. Intern. Med. |volume=136 |issue=9 |pages=652–9 |date=May 2002 |pmid=11992300 |doi= 10.7326/0003-4819-136-9-200205070-00007}}
14. ^{{cite journal |vauthors=Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ |title=Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers |journal=Arch. Intern. Med. |volume=165 |issue=12 |pages=1347–52 |date=June 2005 |pmid=15983282 |doi=10.1001/archinte.165.12.1347 }}
15. ^{{cite journal |vauthors=Lawrence RS, Mickalide AD |title=Preventive services in clinical practice: designing the periodic health examination |journal=JAMA |volume=257 |issue=16 |pages=2205–7 |date=April 1987 |pmid=3560403 |doi= 10.1001/jama.257.16.2205|url=}}
16. ^{{cite journal |vauthors=Frame PS, Carlson SJ |title=A critical review of periodic health screening using specific screening criteria. Part 1: Selected diseases of respiratory, cardiovascular, and central nervous systems |journal=J Fam Pract |volume=2 |issue=1 |pages=29–36 |date=February 1975 |pmid=1123583 |doi= |url=}}
17. ^{{cite journal |author=Beck LH |title=Periodic health examination and screening tests in adults |journal=Hosp Pract (Minneap) |volume=34 |issue=12 |pages=117–8, 121–2, 124–6 |date=November 1999 |pmid=10616549 |doi= 10.3810/hp.1999.11.175|url=}}
18. ^{{Cite web|title = A checkup for the checkup: Do you really need a yearly physical? - Harvard Health Blog|url = http://www.health.harvard.edu/blog/a-checkup-for-the-checkup-do-you-really-need-a-yearly-physical-201510238473|website = Harvard Health Blog|accessdate = 2015-11-02|language = en|date = 2015-10-23}}
19. ^{{cite journal |vauthors=Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL |title=Primary care: is there enough time for prevention? |journal=Am J Public Health |volume=93 |issue=4 |pages=635–41 |date=April 2003 |pmid=12660210 |pmc=1447803 |doi= 10.2105/AJPH.93.4.635|url=http://www.ajph.org/cgi/pmidlookup?view=long&pmid=12660210}}
20. ^{{Cite news|title = What went wrong with Joan Rivers’s last medical procedure: lawsuit|url = https://www.washingtonpost.com/news/arts-and-entertainment/wp/2015/01/28/what-went-wrong-with-joan-riverss-last-medical-procedure-lawsuit/|newspaper = The Washington Post|date = 2015-01-28|access-date = 2015-11-08|issn = 0190-8286|language = en-US|first = Emily|last = Yahr}}
21. ^{{Cite web|title = Minnesota teen Sydney Galleger dies after dental procedure|url = http://www.cbsnews.com/news/minnesota-teen-dies-after-dental-procedure/|website = www.cbsnews.com|accessdate = 2015-11-08}}
22. ^{{Cite web|title = Three Georgia boys die unexpectedly after dental procedure|url = http://www.cbs46.com/story/17793876/3-georiga-boys-die-unexpectedly-after-dental-proceedure|website = www.cbs46.com|accessdate = 2015-11-08}}
23. ^{{cite journal |author=Emerson H |title=Periodic medical examinations of apparently healthy persons |journal=JAMA |volume=80 |issue= 19|pages=1376–1381 |year=1923 |pmid= |doi= 10.1001/jama.1923.26430460003011|url=}}
24. ^1 {{cite journal |author=Han PK |title=Historical changes in the objectives of the periodic health examination |journal=Ann. Intern. Med. |volume=127 |issue=10 |pages=910–7 |date=November 1997 |pmid=9382370 |doi= 10.7326/0003-4819-127-10-199711150-00010}}
25. ^1 {{cite journal|vauthors=Gordon PR, Senf J |title=Is the annual complete physical examination necessary? |journal=Arch. Intern. Med. |volume=159 |issue=9 |pages=909–10 |date=May 1999 |pmid=10326933 |doi=10.1001/archinte.159.9.909 |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10326933 }}{{dead link|date=January 2017 |bot=InternetArchiveBot |fix-attempted=yes }}
26. ^{{cite journal |author=Charap MH |title=The periodic health examination: genesis of a myth |journal=Ann. Intern. Med. |volume=95 |issue=6 |pages=733–5 |date=December 1981 |pmid=7030166 |doi= 10.7326/0003-4819-95-6-733|url=}}
27. ^{{cite journal |author=Davis AB |title=Life insurance and the physical examination: a chapter in the rise of American medical technology |journal=Bull Hist Med |volume=55 |issue=3 |pages=392–406 |year=1981 |pmid=7037084 |doi= |url=}}
28. ^{{cite journal |vauthors=Jureidini R, White K |title=Life insurance, the medical examination and cultural values |journal=J Hist Sociol |volume=13 |issue=2 |pages=190–214 |year=2000 |pmid=18383634 |doi= 10.1111/1467-6443.00113|url=}}
29. ^{{cite journal |vauthors=Olsen DM, Kane RL, Proctor PH |title=A controlled trial of multiphasic screening |journal=N. Engl. J. Med. |volume=294 |issue=17 |pages=925–30 |date=April 1976 |pmid=1256483 |doi=10.1056/NEJM197604222941705 }}
30. ^{{cite journal |author=Knox EG |title=Multiphasic screening |journal=Lancet |volume=2 |issue=7894 |pages=1434–6 |date=December 1974 |pmid=4140342 |doi= 10.1016/S0140-6736(74)90086-5|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(74)90086-5}}

External links

  • [https://www.nlm.nih.gov/medlineplus/healthcheckup.html Health Checkup] - from MedlinePlus
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