Visiting your GP purely to “see if anything is wrong” seems an odd concept to many people.
Many others can see the value in it but never quite get around to it, and a rare few make a point of taking themselves off to their GP on a regular basis for their “regular check-up”, their “well person examination”, or “Warrant of Fitness” so to speak.
Whether your GP has looked after you and three generations of your family for decades, or you have just moved towns and will have to visit a new GP for the first time, giving a GP an opportunity to review your state of wellness is analogous to letting a lawyer review your state of legal affairs.
It is invariably insightful and often timely and beneficial. So goes the adage “an ounce of prevention is worth a pound of cure”.
When you attend your GP for a wellness check, they will start off by talking about your history. They will review any conditions you are known to have, and consider on your family history.
It is always good to know as much as you can about illnesses that may have been prevalent in your family. Cardiovascular disease – heart attacks and strokes, and cancers – are of particular interest, as well as diabetes, high blood pressure and other conditions that are known to run in families, like depression.
Then we ask about habits and routines that influence your health – alcohol use, smoking or other drug use, your activity levels, your relationship, whether you have children, your work and potential for work stress.
Symptoms to consider
Assuming you have no pressing concerns about any medical conditions you are known to have then the doctor will move on to questions about symptoms that may suggest something of interest to delve deeper about. Here is a list of symptoms that we commonly ask about, working from head to toe.
Reviewing this list yourself as you read through it could provide an indication as to whether booking a wellness check is important to you in the near future:
- Headaches, migraines, particularly a new or a change of headache pattern, change of your vision.
- Recurrent nasal or sinus congestion, hay fever, ear or hearing problems, snoring.
- Lumps or persistent swollen glands in your neck, under your arms or in your groin.
- Cough, chest pain, shortness of breath, either at rest or on exertion or a decreasing exercise tolerance. Any wheeziness, particularly at night or after exercise.
- Upset stomach, indigestion, altered bowel habit and particularly any blood in your stool.
- Alteration to how you pass urine, needing to go more frequently, getting up at night to pass water, hesitancy, accidents – either where you can’t hold on or where you leak when you laugh, jump or run.
- Periods and gynaecological concerns for women.
- Male specific “men’s health” concerns for men.
- Contraceptive needs and any requirement for sexually transmitted infection testing, for all.
- Sore or swollen joints, sore muscles, back or neck pain.
- Alteration in your co-ordination, dizziness, problems with sleep – either too much or if you are unable to. Weight gain or loss. Fatigue.
- Any skin concerns, rashes or concerning moles or moles that have changed.
- We may ask general questions about stress levels and how you feel that your mood is.
After completing the “review of systems” and following any line of enquiry that those screening questions raise then a physical examination is conducted.
Your height and weight should be documented and comment made on how appropriate your weight is for your height.
The silent killer
Hypertension is the silent killer. It can slowly, insidiously contribute to narrowing or weakening of the arteries that in later years can cause heart attacks or strokes. The importance of regular blood pressure checks increases as you get older and by the time you get to your 40s you should almost be getting this annually depending on what your blood pressure usually is. It is good to get done at any age and it is especially good to pick up those rare young people who have hypertension from their 20s or 30s.
From taking the pulse and blood pressure we work around the body systematically. Feeling for abnormally enlarged lymph nodes (your “glands”) listening to your heart and lungs, examining your abdomen where we check for enlargement of the spleen and liver and – of particular importance as one gets older – check for a slow enlargement of the large artery in the abdomen, the “aorta”, which if detected early can be effectively treated avoiding the major catastrophe of a “ruptured abdominal aortic aneurysm” or AAA.
If you are a male around age 50 then a discussion will be had about a prostate exam and for our female patients consideration of a breast exam and checking that your cervical smear is up to date.
Most GPs have expertise in the identification and diagnosis of suspicious skin lesions and moles and any moles of concern can be checked. A full all over skin check is reasonable to do at any age.
It takes time
To do this process properly usually takes a double appointment – to give the GP about 30 minutes.
Having reviewed the questions above will help you get the most out of the process and allow the consultation to be spent on a thorough physical examination and allow time for discussion about concerns raised or getting individualised wellness advice.
A GP may then want to do some investigations or at the very least some blood tests before being able to summarise and conclude the state of your health. They may be happy to communicate this to you by letter or text, or have you return for a further consultation, especially if matters were identified that need further investigation or treatment.
There are a number of investigations that become relevant to consider at different ages and stages of life. This “targeted screening” is another way of maintaining wellness by detecting potentially serious conditions when they are at an early more easily treatable stage, and is the topic of my next “Practising Well” article.
Dr Michael Buckley FRNZCGP is a GP practising in the Wellington region. He divides his time between part-time practice and helping look after his young family. He appreciates the importance and challenge of maintaining a lifestyle that allows one to “practise well”.