The Reality Check Check-Up Checklist

Our bodies act as vehicles, and as with most vehicles, there are maintenance schedules that, if followed, ensure they to remain in the best possible shape for as long as possible. I like to tell my patients that we do not wait for planes to crash before tuning them up. We check everything before even starting the engines to maximize the probability for the best outcome, and no one quibbles about the cost of aircraft maintenance.

This approach can be applied to the human body as well. I’m a believer in verifying health rather than merely assuming it, and performing regular, thorough health “maintenance” is the only way to verify health. For our bodies, the tuneup is an annual physical. I always review health statistics and trends and apply them to every patient I see. Over the years, I’ve developed the Check-Up Checklist, a list of specific tests that I conduct for every patient’s annual physicals:

  • A complete physical exam, including a thorough review of the patient’s personal and family health history and genetic predisposition.
  • Complete bloodwork, including blood count, chemistries, thyroid, lipids, homocystine, C-reactive protein (or CRP) and prostate specific antigen test (for men age 35 and up)
  • Urinalysis
  • Chest X-ray (two views of the lungs)
  • Colonoscopy starting at age 40 and at least every 5 years afterward
  • For women: pelvic exam, pap smear, testing for human papilloma virus, mammogram after age 35 and a pelvic sonogram after age 40 (every other year)

Other tests should be conducted every few years:

  • Cardiac stress test and echocardiography at age 40-45 and up every three to five years or annually if the patient is at risk
  • Bone-density testing for women at 50 and men at 55 every one to two years
  • 64 slice CT-angiogram of the chest and coronary arteries every three years beginning at age 50.
  • Advanced lipid (VAP) testing to detect small lipid particles that would not appear in routine cholesterol testing, every three years beginning at age 25

The goal of the Check-Up Checklist is to avoid being blind-sided by something that could have been detected in its earlier stages and either prevented, modified, or cured. These tests include upgrades that can provide huge values to the patient’s future health.  By following this type of physical, my patients have fewer coronary problems and very few visits to the hospital.

As much as I believe in such aggressive testing, insurance companies will not always cover these tests and doctors often succumb to financial pressures and will not always order these tests. Nevertheless, there are ways that doctors and health professionals can work with patients to make the tests more affordable. After more than 25 years of seeing patients, I have found that this nontraditional approach keeps my patients healthy and out of my office or the hospital.

Keep in mind that this maintenance schedule is not the sole responsibility of the doctor. As patients, each of us are the other half of our maintenance team, and we should not be shy about asking for or even demanding these tests. After all, it’s our health that’s at stake. And what can be more affordable in the long term than good health?


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