Michael Bradshaw, Health check: leader's guide, Kansas State University, August 1998

Bradshaw, Michael H.

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HealthCheckLEADER’S GUIDEKansas State University Agricultural Experiment Station and Cooperative Extension ServicePLANNING THE LESSONTo prepare this lesson, read thisleader’s guide and the publicationMF-2357 Personal Medical Checkup.For your lesson, you may want to:• review the material, which is in aquestion/answer format, found inthis teaching guide.• review the chart in the participanthandout entitled “Major ScreeningTests.”• organize the lesson to fit yourteaching style.Material needed:• One copy for each participant ofPersonal Medical Checkup.• A copy of the program evaluationat the end of this guide.LESSON NOTES• Many of us like to talk about ourhealth. Be careful that the lessondoesn’t turn into a sharing ofhealth problems. You may have toredirect discussion if people starttalking about surgery, cancer orpast health exams.• Any discussion of health cliniciansshould remain on a high level.Some people tend to blame theclinician for their health problems.OBJECTIVESAt the conclusion of the lesson, par-ticipants will be able to:• describe common screening tests.• explain the importance of age,gender, family, and medical historyin determining the frequency andtypes of tests used.• explain why clinicians have movedaway from annual medical exams.INTRODUCTIONThe scope of medical checkups is a source of considerable disagreement. Somepeople believe everyone should have a yearly checkup; others think a medicalcheckup is needed only about every two to three years. Patients observe dis-agreement among health agencies and health professionals as to how often aparticular screening test should be offered. In addition, there is disagreementin the medical community as to which screening tests are effective.This lesson focuses on common screening tests professionals feel are essentialin health management. The lesson relies heavily on recommendations of theU.S. Preventive Service Task Force* for medical checkup guidelines.WHAT IS THE HISTORY OF THE MEDICAL EXAMINATION?The periodic exam is believed to have its origin in June 1900, when Dr.George M. Gould suggested to the American Medical Association (AMA)that it was necessary to perform periodic medical examinations if physicianswere to practice preventive medicine. In 1922, the AMA’s House of Delegatesauthorized the preparation of routine medical checkup forms for doctors, fol-lowed by a physician’s manual for routine health examinations. The routineforms and manual brought standardization to the exam. The regular examina-tions were strengthened by a 1947 recommendation that individuals over 35have a yearly examination.  In 1983, the AMA moved away from the yearlyexam. Now the group suggests that patients have medical checkups every fiveyears until age 40 and every one to three years thereafter.WHY HAVE HEALTH CLINICIANS MOVED AWAY FROM THEANNUAL MEDICAL EXAM?Patients under 50 years of age are relatively free from disease that can be diag-nosed by a physical exam. Most health problems must manifest themselves inthe form of signs or symptoms before they can be recognized. In addition,some exams are not cost-effective. For example, a chest X-ray seldom revealsdisease in younger patients, who are at low risk for such lung diseases as tuber-culosis and cancer.WHAT IS A SCREENING TEST?Screening is an examination (or test) for early signs of a certain type of disease,even though there may be no symptoms. To learn who is more likely to get aparticular disease, scientists have studied disease patterns in the population. Thisinformation helps clinicians recommend which patients should be screened forwhat types of diseases, and how often these tests should be done.Not all screening tests are helpful, though, and some have risks. If your clini-cian suggests certain screening tests as part of your health care exam, this doesnot mean he or she thinks you have a particular disease. Screening tests aredone when you have no symptoms. If you have symptoms of a particular dis-ease, your clinician may order diagnostic tests to verify presence of the disease.* U.S. Preventive Service Task Force is a panel of physicians under the direction ofthe U.S. Department of Health and Human Services. It studies the effectiveness ofscreening tests for early detection of disease.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.HOW OFTEN WILL YOUR CLINICIAN WANTYOU TO HAVE A HEALTH EXAMINATION?The American Medical Association suggests that peoplehave medical checkups every five years until age 40 andthen every one to three years thereafter. Some cliniciansuse this rule of thumb: For individuals in their twenties —two exams during that time period; in their thirties —three exams; forties — four exams. An annual healthexam is recommended for most patients after age 50.HEALTH CHECKWHAT MIGHT A PERSON EXPECT TODAY FROMA HEALTH EXAMINATION?A health exam usually includes filling out a family historyform, if one is not on file. The clinician will check eyes,ears, nose, throat, heart, height, weight, abdomen, lungs,neurological and skeletal systems, breast, cervix, and uri-nary tract. A urine specimen is used to test problems withkidneys, and  a  blood sample may be taken to check cho-lesterol levels and any iron deficiency.The physician may request additional tests, depending onage, gender, medical history and family history. A chest X-ray, EKG, rectal examination or stress test may be ordered.The clinician may suggest lifestyle changes and call forhealth interventions.S P E C I F I C   T E S T SPlease refer to the “Major Screening Tests” portion of the fact sheet as we review some of the more common screening tests.LET’S LOOK FIRST AT BLOOD PRESSURE SCREENING.WHO NEEDS THE SCREENING? HOW OFTEN?Periodic screening for hypertension is recommended forall adults. The regularity of blood pressure screening is leftto clinical discretion. Current expert opinion is thatadults who are believed to have normal blood pressureshould receive blood pressure measurements at least onceevery two years. If your blood pressure moves up towardthe high range, your clinician will want to check it moreoften. Measurement of blood pressure during office visits isalso recommended for children and adolescents.Blood pressure cuff remains the most appropriate screeningtest for hypertension. The patient can be the source of mis-leading readings due to posture and arm position. Biologicalfactors that can cause faulty readings include anxiety, meals,tobacco, alcohol, temperature changes, exertion and pain.Due to these limitations, it is recommended that hyperten-sion be diagnosed only after more than one elevated readingis obtained on each of three separate visits over a period ofone to several weeks or in a different environment.BLOOD CHOLESTEROL SCREENINGPeriodic screening for high blood cholesterol is recom-mended for all men ages 35-65 and women ages 45-65.There is insufficient evidence to recommend for or againstroutine screening of people without symptoms who areover age 65. Recommendations to screen healthy men andwomen ages 65-75 may be made on other grounds. Thereis also insufficient evidence to recommend for or againstscreening in children, adolescents or young adults. Rec-ommendations can be made for screening adolescents andyoung adults with risk factors for coronary disease.SCREENING FOR CERVICAL CANCERRoutine screening for cervical cancer with Pap testing isrecommended for all women 18 years of age or who are orhave been sexually active and who have a cervix. Papsmears should be repeated at least every 3 years. There isinsufficient evidence to recommend for or against an up-per age limit for Pap testing, but recommendations can bemade on other grounds to discontinue regular testing afterage 65 in women who have had regular previous screeningin which the smears have been consistently normal.Women can work with the clinician to make this decision.Approximately 16,000 cases of cervical cancer are diag-nosed each year, and about 4,800 women die from this dis-ease annually. The lifetime risk of dying from cervicalcancer in the United States is 0.3 percent. The five-yearsurvival rate is about 90 percent for women with localizedcervical cancer; it is considerably lower (about 14 per-cent) for those with advanced disease.SCREENING FOR BREAST CANCERRoutine screening for breast cancer every one to two years,with mammography alone or mammography and annualclinical breast examination, is recommended for womenage 50-69. There is insufficient evidence to recommend foror against routine mammography or clinical breast exami-nation for women age 40-49 or age 70 and older, althoughrecommendations for high-risk women age 40-49 andhealthy women age 70 and older may be made on othergrounds. Work with your clinician to make this decision.In 1995, there were an estimated 182,000 new cases ofbreast cancer diagnosed and 46,000 deaths from this dis-ease in American women. Approximately 32 percent ofOutdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.all newly diagnosed cancers in women are cancers of thebreast, the most common cancer diagnosed in women.The annual incidence of breast cancer increased 55 per-cent between 1950 and 1991. The incidence in womenduring the period 1987-1991 was 110 per 100,000.SCREENING FOR COLORECTAL CANCERScreening for colorectal cancer is recommended for indi-viduals age 50 and older, with annual fecal occult bloodtesting and sigmoidoscopy every three to 10 years, on pro-fessional advice. Clinicians study the health of the rectumand colon with a viewing tube called an endoscope. Thislighted viewing tube is used to examine the rectum andlower portion of the large intestine (sigmoidoscopy) andthe entire large intestine (colonoscopy).PROSTATE SCREENINGThe prostate specific antigen (PSA) test measures the in-creased level of protein antigen usually present when thereis a cancer tumor. There are questions of what to do if thetest is positive, but no cancer is found. The protein antigenrises with some urinary tract infections. A very high level ofantigen usually means the cancer is large and has alreadyspread. Small elevations may not mean anything and arevery hard to interpret. A level below 4 Ng/ml (nanogramsper milliliter) is normal. A level between 4 and 10 Ng/ml isconsidered elevated. A level higher than 10 Ng/ml is astrong indication of cancer. The patient may choose to gothrough expensive testing or surgery to see if it is cancer.(University of California at Berkeley Wellness Letter, July 1995)The digital rectal exam is performed by a doctor throughthe rectum to examine the lower part of the prostate gland.The prostate gland is examined for abnormalities. The pros-tate in older patients is often enlarged, stiff and inflexible.LEADER’S GUIDENodules on the prostate raise the question of cancer. Pros-tate cancer is the most common non-skin cancer in Ameri-can men. After lung cancer, it accounts for more cancerdeaths in men that any other single cancer site. Prostatecancer accounted for an estimated 244,000 new cases and40,400 deaths in the United States in 1995.What are the risks?Cancer of the prostate is rare in young men but becomesmore common with age. It occurs in fewer than one manin 10,000 from age 40 to 50. Risk increases with age, be-ginning at age 50, and is also higher among AfricanAmerican men. It is slow growing and can metastasize(spread) if it goes undetected.THYROID DISEASERoutine screening for thyroid disease is not recommendedfor asymptomatic children or adults.  Clinicians should bealert to subtle symptoms and signs of thyroid dysfunctionwhen examining patients. Examples of such symptoms in-clude easily becoming fatigued, weight gain, dry skin orhair, cold intolerance, difficulty concentrating, depression,nervousness and palpitations.GLAUCOMA SCREENINGIndividuals who are over 65, have severe myopia or diabe-tes, or who are African American should be evaluated byan eye specialist. Many eye specialists advise screening alladults starting at age 40.  Glaucoma is a disorder defined byslowly progressive loss of vision associated with characteris-tic signs of damage to the optic nerve. Increased pressureinside the eye is common in glaucoma and is believed tocontribute in damaging the optic nerve. Glaucoma is thesecond leading cause of irreversible blindness in the UnitedStates and the leading cause among African Americans.P R E V E N T I O NClinicians have been incorporating prevention into medicalpractice for the past 30 to 40 years.  Infectious diseases suchas poliomyelitis—which once occurred in regular epidemicwaves (more than 18,300 cases in 1954)—have become rarein the United States as a result of childhood immuniza-tion.  Only three cases of paralytic poliomyelitis were re-ported in the nation in 1993, none due to the wild virus.Before rubella vaccine became available, rubella epidem-ics occurred regularly in the United States every six tonine years; a 1964 outbreak resulted in more than 12 mil-lion rubella infections, 11,000 fetal losses, and about20,000 infants born with congenital rubella syndrome(deafness, eye defects, cardiac defects, neurologic abnor-malities). The incidence of rubella has decreased 99 per-cent since 1969, when the vaccine first became available.Similar trends have occurred with diphtheria, pertussis,and other once-common childhood infectious diseases.Although immunization and screening tests remain impor-tant preventive services, the most promising role for preven-tion in current medical practice may lie in changing thepersonal health behaviors of patients long before clinicaldisease develops. Approximately half of all deaths occurringin the United States may be attributed to external factors:tobacco, alcohol, and illicit drug use; diet and activity pat-terns; motor vehicles; and sexual behavior. All are poten-tially preventable by changes in personal health practices.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.HEALTH CHECK LEADER’S GUIDEPublications from Kansas State University are available on the World Wide Web at: http://www.oznet.ksu.eduContents of this publication may be freely reproduced for educational purposes. All other rights reserved. In each case, credit Michael Bradshaw, Ph.D., “Health Check,” Kansas State University, August 1998.Kansas State University Agricultural Experiment Station and Cooperative Extension ServiceMF-2356 AUGUST 1998It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all persons shall have equal opportunity and access to its educational programs, services, activities, and materialswithout regard to race, color, religion, national origin, sex, age or disability. Kansas State University is an equal opportunity organization. Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, asamended. Kansas State University, County Extension Councils, Extension Distr icts, and United States Department of Agriculture Cooperating, Marc A. Johnson, Director.File code: HEALTH AND SAFETY NP C OM M U N I T Y    S E R V I C E    A C T I V I T I E S• Create a media awareness campaign to encourage people to visit their clinician for a checkup.• Assist the health department in screening activities.• Organize a screening activity for a group of people in the community who may be difficult to reach.  It may be a church group orindividuals who are not available for screenings at regular clinic hours.PROGRAM EVALUATIONAt the end of the program, ask participants to complete copies of the program evaluation. Return the completed evaluation toyour county agent.PROGRAM EVALUATIONCounty:   ________________________________________________ Date:   _______________________________HEALTH CHECKCircle your answers to questions I through III:I . How do you rate this program in general?• Met my expectations EXCELLENT GOOD FAIR POOR• Subject matter EXCELLENT GOOD FAIR POOR• Usable information EXCELLENT GOOD FAIR POORII. As a result of this program:• I gained knowledge MUCH SOME LITTLE NONE• I will use the information MUCH SOME LITTLE NONEIII.As a result of this program, do you have an improved understanding of:• History of the medical examination YES NO• Screening tests and why they are used YES NO• The type of screening tests you may be asked to take during your next medical exam YES NO• How often your clinician will want you to have a medical exam YES NO• The counseling topics that may be discussed by your clinician YES NOIV. Additional comments/suggestions:REFERENCES:Guide to Clinical Preventive Services, 2nd Edition, Internal Medical Publishing, Inc., Alexandria, Va.PREPARED BY:Michael Bradshaw, Ph.D., Extension Specialist, Health and Safety, Kansas State UniversityThanks to reviewers Libby Curry, Northwest Area Office, Extension Specialist, Family and Consumer Sciences; and James Dixon Gardner, M.D.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.

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