Doc: Annual physical often a hands-on experience
Dear Dr. Roach: I am a 75-year-old female in fairly good health. I take statins to keep my cholesterol under control, and am being followed by an endocrinologist for a parathyroid problem, which also is under control. For the past two years, when I visit my physician for an annual wellness check, I have some blood work done before our visit and fill out a health risk assessment.
Other than having my blood pressure taken, the doctor talks to me, but does no other physical exam. My heart is not listened to, and no part of my body is touched. I am told that Medicare will not pay for any kind of physical exam and that is all the doctor will do. In the past I have had some medical problems found because the doctor has done a more-extensive exam.
Is this new type of exam adequate?
Dear R.D.: No, and this is not what is supposed to happen at an annual wellness exam.
Instead of trying to deal with known problems, the purpose of this special annual visit is to encourage the doctor to take extra time to listen to you, do a full exam and evaluate how to prevent new problems and screen for any you may have but don’t know about yet.
This includes discussing periodic health checks like mammograms or colonoscopies, but the physical exam essentially is a series of screening tests. Some have a higher yield than others; however, the explanation that “Medicare will not pay for a physical exam” is simply not true. The annual wellness check is the time to do as complete a history and a physical, as is appropriate.
Dear Dr. Roach: I am an active 72-year-old woman. I am a salesperson and need to be able to talk on the phone and network with people. My voice began to crack and my speech became more difficult to understand when I was 40 years old. Fifteen years ago, I was tested for spasmodic dysphonia, but although I had all the symptoms, they could not find anything wrong. Do you have any suggestions?
Dear C.J.: Spasmodic dysphonia is a localized nerve problem, isolated to the nerves of the vocal cords. It causes variable voice changes, sometimes a whispering and breathy voice, but also voice breaks and a strained-sounding voice. The diagnosis is confirmed by looking at how the vocal cords move during speech.
Because your symptoms have lasted so long, and especially because of your profession, I think it is worthwhile to get another evaluation. Experts in this field include head and neck surgeons (ENT), neurologists, and speech and language pathologists.
If you do get a diagnosis, treatment often includes speech therapy, sometimes medication and occasionally surgery.
You can read more at dysphonia.org.
Email questions to ToYourGoodHealth@med.cornell.edu.