Medical Check-up and Medical Screening?
When a patient comes to his/her physician with the onset of new symptoms or a suspected illness, doctors will almost always take a good history and perform a physical examination. Based upon the history and physical exam, the diagnosis could be clear and treatment could be recommended at this point. This would be the most simple and ideal category of patient consultation and of Investigative Medicine. In other situations further clinical investigations (tests) are or can be recommended to the patient to obtain key information and determine the diagnosis if many or more than one possible condition could be the cause of the illness or symptoms. This the difference between Investigative Medicine, when a patient has symptoms and there is an obligation is to investigate, and Screening Medical Programs which take on “patients” who are having no symptoms and otherwise feel in their usual state of health.
What is a Medical Check-Up? A Medical Check-Up actually has no definitive definition. It could simply represent an annual history and physical exam by your physician, and if you are young and healthy, and have no risk factors for disease, it should not lead to a lot of medical tests. There are many Medical Check-Up packages that regardless of age, or risk factors, that are offered to many patients that include a large number of tests which are promoted as screening tests. Many people may perceive or feel that the more tests performed means a more thorough examination, or “getting more for your money”, the same way as when people go into a grocery store and see a product deal such as buy 2 get one free. There are many reasons why this does not work with screening tests.
What is Screening then? Screening is looking for disease in those that are not suspected of having the disease, except based on probabilities, often low probabilities. Screening is different from investigation, in which tests are ordered when a patient has symptoms and disease is suspected. A screening test is the initial test that is performed to “look” for a disease not actually suspected. If a screening test returns positive, it could often lead to many other diagnostic tests to investigate the positive test. Therefore, a screening test, if it is not used and applied properly, can sometimes lead to many additional inappropriate tests, scans, and other medical diagnostic tests that the patient would not have initially suspected could be involved. Hippocrates, the ancient historical Greek physician told physicians “First Do No Harm” as the first principle of medical practice.
Each individual is different and each region can be different. As an example, in Viet Nam, there is a high incidence of the chronic liver virus infections called Hepatitis B and Hepatitis C, and from this knowledge recommendations can be given for screening and testing people who are Vietnamese and people who are living in Vietnam for liver disease and for the presence of one of these viruses. One good reason in Viet Nam for knowing your Hepatitis B immune status is that people who are not immune to the Hepatitis B virus can be vaccinated and the infection and possible complications from the infection can be prevented entirely for life.
This article here is not meant to go into the value and merits of every screening test, but meant to advise concerned patients that they should consider carefully which tests they allow to be done on themselves, as getting more tests is usually not better. This is where seeing your doctor first, who can take a good history and physical exam before extensive screening tests are performed is the real cornerstone to appropriate screening.
At the Stamford Medical Centre, we do offer Medical Check-up packages that include some tests that we feel represent a balanced and reasoned approach to screening for fairly common medical conditions and diseases that our patients could have exposure to in Viet Nam. We, however, welcome any patient to call and enquire in regards to their situation and an appropriate medical chek-up, and even more so welcome each patient to have a good history and physical exam initially and then receive counseling as to their best choices for possible screening tests/screening programs.
A URL link is provided below to United States Preventive Services Preventive Task Force that can give patients a better understanding about which screening tests and programs have been shown to be effective and at what ages and what factors dictate how these programs should be used;
http://www.ahrq.gov/clinic/uspstfix.htm
These recommendations are however written for the US population while in Viet Nam as noted above we have different exposure risks.
Mark Siefring M.D. M.S. ABIM
When a patient comes to his/her physician with the onset of new symptoms or a suspected illness, doctors will almost always take a good history and perform a physical examination. Based upon the history and physical exam, the diagnosis could be clear and treatment could be recommended at this point. This would be the most simple and ideal category of patient consultation and of Investigative Medicine. In other situations further clinical investigations (tests) are or can be recommended to the patient to obtain key information and determine the diagnosis if many or more than one possible condition could be the cause of the illness or symptoms. This the difference between Investigative Medicine, when a patient has symptoms and there is an obligation is to investigate, and Screening Medical Programs which take on “patients” who are having no symptoms and otherwise feel in their usual state of health.
What is a Medical Check-Up? A Medical Check-Up actually has no definitive definition. It could simply represent an annual history and physical exam by your physician, and if you are young and healthy, and have no risk factors for disease, it should not lead to a lot of medical tests. There are many Medical Check-Up packages that regardless of age, or risk factors, that are offered to many patients that include a large number of tests which are promoted as screening tests. Many people may perceive or feel that the more tests performed means a more thorough examination, or “getting more for your money”, the same way as when people go into a grocery store and see a product deal such as buy 2 get one free. There are many reasons why this does not work with screening tests.
What is Screening then? Screening is looking for disease in those that are not suspected of having the disease, except based on probabilities, often low probabilities. Screening is different from investigation, in which tests are ordered when a patient has symptoms and disease is suspected. A screening test is the initial test that is performed to “look” for a disease not actually suspected. If a screening test returns positive, it could often lead to many other diagnostic tests to investigate the positive test. Therefore, a screening test, if it is not used and applied properly, can sometimes lead to many additional inappropriate tests, scans, and other medical diagnostic tests that the patient would not have initially suspected could be involved. Hippocrates, the ancient historical Greek physician told physicians “First Do No Harm” as the first principle of medical practice.
Each individual is different and each region can be different. As an example, in Viet Nam, there is a high incidence of the chronic liver virus infections called Hepatitis B and Hepatitis C, and from this knowledge recommendations can be given for screening and testing people who are Vietnamese and people who are living in Vietnam for liver disease and for the presence of one of these viruses. One good reason in Viet Nam for knowing your Hepatitis B immune status is that people who are not immune to the Hepatitis B virus can be vaccinated and the infection and possible complications from the infection can be prevented entirely for life.
This article here is not meant to go into the value and merits of every screening test, but meant to advise concerned patients that they should consider carefully which tests they allow to be done on themselves, as getting more tests is usually not better. This is where seeing your doctor first, who can take a good history and physical exam before extensive screening tests are performed is the real cornerstone to appropriate screening.
At the Stamford Medical Centre, we do offer Medical Check-up packages that include some tests that we feel represent a balanced and reasoned approach to screening for fairly common medical conditions and diseases that our patients could have exposure to in Viet Nam. We, however, welcome any patient to call and enquire in regards to their situation and an appropriate medical chek-up, and even more so welcome each patient to have a good history and physical exam initially and then receive counseling as to their best choices for possible screening tests/screening programs.
A URL link is provided below to United States Preventive Services Preventive Task Force that can give patients a better understanding about which screening tests and programs have been shown to be effective and at what ages and what factors dictate how these programs should be used;
http://www.ahrq.gov/clinic/uspstfix.htm
These recommendations are however written for the US population while in Viet Nam as noted above we have different exposure risks.
Mark Siefring M.D. M.S. ABIM