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Screening/Physical Exam/Health Maintenance

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Abstract

Traditional medical pedagogy stresses the importance of a complete patient history and physical exam. Though this is extremely relevant for the purposes of learning and perfecting skills, the reality of clinical practice does not allow the clinician to complete a full examination at each patient visit. Therefore, clinicians need to decide how to narrow the focus. When is it appropriate to perform focused history taking and examinations? What can the clinician use to guide these decisions? Evidence-based recommendations for prevention and screening can support the decision process and help guide the content of the encounter with the patient and the care provided. This chapter will highlight the importance of prevention, harm reduction, and thoughtful screening to better inform the physical examination and health maintenance planning.

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References

  1. Office of Disease Prevention and Health Promotion. Social determinants of health. Healthy People 2030. 2020. https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Accessed 12 Nov 2021.

  2. World Health Organization. Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed 2 Jan 2022.

  3. Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ. 2016;188(17–18):E474–83. https://doi.org/10.1503/CMAJ.160177/-/DC1.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Prevention. Picture of America. 2017. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf. Accessed 2 Jan 2022.

  5. Stockings E, Hall WD, Lynskey M, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry. 2016;3(3):280–96. https://doi.org/10.1016/S2215-0366(16)00002-X.

    Article  Google Scholar 

  6. Tatarsky A. Harm reduction psychotherapy: extending the reach of traditional substance use treatment. J Subst Abuse Treat. 2003;25(4):249–56. https://doi.org/10.1016/S0740-5472(03)00085-0.

    Article  Google Scholar 

  7. Hawk M, Coulter RWS, Egan JE, et al. Harm reduction principles for healthcare settings. Harm Reduct J. 2017;14(1):70. https://doi.org/10.1186/S12954-017-0196-4/TABLES/2.

    Article  Google Scholar 

  8. U.S. Preventive Services Taskforce. About the USPSTF. https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf. Accessed 2 Jan 2022.

  9. U.S. Preventive Services Taskforce. A and B recommendations. 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. Accessed 2 Jan 2022.

  10. U.S. Preventive Services Taskforce. Grade definitions. 2018. https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/grade-definitions. Accessed 2 Jan 2022.

  11. U.S. Preventive Services Task Force. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;151(11):784. https://doi.org/10.7326/0003-4819-151-11-200912010-00006.

    Article  Google Scholar 

  12. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2004;140(7):557–68. https://doi.org/10.7326/0003-4819-140-7-200404060-00017/SUPPL_FILE/WHITLOCK_AT3_140-7-557-DC1-2.PDF.

    Article  Google Scholar 

  13. O’Connor E, Rossom RC, Henninger M, et al. Screening for depression in adults. Rockville: Agency for Healthcare Research and Quality (US); 2016. https://www.ncbi.nlm.nih.gov/books/NBK349027/. Accessed 2 Jan 2022.

    Google Scholar 

  14. DeSantis B, Jackson MJ, Duncan BL, Reese RJ. Casting a wider net in behavioral health screening in primary care: a preliminary study of the outcome rating scale. Prim Health Care Res Dev. 2017;18(2):188–93. https://doi.org/10.1017/S1463423616000311.

    Article  Google Scholar 

  15. Irwig L, McCaffery K, Salkeld G, Bossuyt P. Screening and choice: informed choice for screening: implications for evaluation. BMJ. 2006;332(7550):1148. https://doi.org/10.1136/BMJ.332.7550.1148.

    Article  Google Scholar 

  16. Sydney E, Weinstein E, Rucker LM. Handbook of outpatient medicine. Springer International Publishing; 2018. https://doi.org/10.1007/978-3-319-68379-9.

  17. Ong LML, de Haes JCJM, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18. https://doi.org/10.1016/0277-9536(94)00155-M.

    Article  CAS  Google Scholar 

  18. Lipkin M. Patient education and counseling in the context of modern patient-physician-family communication. Patient Educ Couns. 1996;27(1):5–11. https://doi.org/10.1016/0738-3991(95)00784-9.

    Article  Google Scholar 

  19. Singh H, Vij MS. Eight recommendations for policies for communicating abnormal test results. Jt Comm J Qual Patient Saf. 2010;36(5):226–32. https://doi.org/10.1016/S1553-7250(10)36037-5.

    Article  Google Scholar 

  20. Leekha S, Thomas KG, Chaudhry R, Thomas MR. Patient preferences for and satisfaction with methods of communicating test results in a primary care practice. Jt Comm J Qual Patient Saf. 2009;35(10):497–501. https://doi.org/10.1016/S1553-7250(09)35068-0.

    Article  Google Scholar 

  21. Paltzer J, Brown RL, Burns M, et al. Substance use screening, brief intervention, and referral to treatment among medicaid patients in Wisconsin: impacts on healthcare utilization and costs. J Behav Health Serv Res. 2017;44(1):102–12. https://doi.org/10.1007/S11414-016-9510-2.

    Article  Google Scholar 

  22. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1–3):280–95. https://doi.org/10.1016/J.DRUGALCDEP.2008.08.003.

    Article  Google Scholar 

  23. National Council for Mental Wellbeing. implementing care for alcohol & other drug use in medical settings: an extension of SBIRT. 2018.

    Google Scholar 

  24. Kisling LA, Das JM. Prevention strategies. Treasure Island: StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK537222/. Accessed 2 Jan 2022.

    Google Scholar 

  25. US Preventive Services Task Force. Prostate cancer: screening. 2018.

    Google Scholar 

  26. Moyer VA. Screening for prostate cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2012;157(2):120–34. https://doi.org/10.7326/0003-4819-157-2-201207170-00459.

    Article  Google Scholar 

  27. Wilt TJ. The prostate cancer intervention versus observation trial: VA/NCI/AHRQ cooperative studies program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy with watchful waiting for men with clinically localized prostate cancer. J Natl Cancer Inst Monogr. 2012;2012(45):184–90. https://doi.org/10.1093/JNCIMONOGRAPHS/LGS041.

    Article  Google Scholar 

  28. Welch HG, Schwartz LM, Woloshin S. Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. J Natl Cancer Inst. 2005;97(15):1132–7. https://doi.org/10.1093/JNCI/DJI205.

    Article  Google Scholar 

  29. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95. https://doi.org/10.1001/ARCHINTE.158.16.1789.

    Article  CAS  Google Scholar 

  30. Buchsbaum DG, Buchanan RG, Welsh J, Centor RM, Schnoll SH. Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc. 1992;40(7):662–5. https://doi.org/10.1111/J.1532-5415.1992.TB01956.X.

    Article  CAS  Google Scholar 

  31. Bradley KA, Bush KR, McDonell MB, Malone T, Fihn SD. Ambulatory care quality improvement project. Screening for problem drinking: comparison of CAGE and AUDIT. J Gen Intern Med. 1998;13(6):379–88. https://doi.org/10.1046/j.1525-1497.1998.00118.x.

    Article  Google Scholar 

  32. Van Stralen KJ, Stel VS, Reitsma JB, Dekker FW, Zoccali C, Jager KJ. Diagnostic methods I: sensitivity, specificity, and other measures of accuracy. Kidney Int. 2009;75(12):1257–63. https://doi.org/10.1038/KI.2009.92.

    Article  Google Scholar 

  33. Mavriplis CA. Should we abandon the periodic health examination?: NO. Can Fam Physician. 2011;57(2):159. /pmc/articles/PMC3038802/. Accessed 2 Jan 2022.

    Google Scholar 

  34. Mavriplis CA. Rebuttal: should we abandon the periodic health examination?: NO. Can Fam Physician. 2011;57(2):e43. /pmc/articles/PMC3038829/. Accessed 2 Jan 2022.

    Google Scholar 

  35. Jauhar S. The demise of the physical exam. N Engl J Med. 2009;354(6):548–51. https://doi.org/10.1056/NEJMP068013.

    Article  Google Scholar 

  36. Connan AL. The consultation and physical examination. Br J Gen Pract. 2009;59(564):544–5. https://doi.org/10.3399/BJGP09X453639.

    Article  Google Scholar 

  37. Phoon CKL. Must doctors still examine patients? Perspect Biol Med. 2000;43(4):548–61. https://doi.org/10.1353/PBM.2000.0050.

    Article  CAS  Google Scholar 

  38. Rice T. Listening as touching and the dangers of intimacy. Earshot. 2007. https://ore.exeter.ac.uk/repository/handle/10871/20447. Accessed 2 Jan 2022.

  39. Robbins J, Bertakis K, Helms L, Azari R, Callahan E, Creten D. The influence of physician practice behaviors on patient satisfaction. Fam Med. 1993;25(1):17–20. https://pubmed.ncbi.nlm.nih.gov/8454118/. Accessed 2 Jan 2022.

    CAS  Google Scholar 

  40. Kravetz RE. To touch or not to touch: that is the question. Am J Gastroenterol. 2009;104(9):2143–4. https://doi.org/10.1038/AJG.2009.478.

    Article  Google Scholar 

  41. Reilly BM, Smith CA, Lucas BP. Physical examination: bewitched, bothered and bewildered. Med J Aust. 2005;182(8):375–6. https://doi.org/10.5694/J.1326-5377.2005.TB06752.X.

    Article  Google Scholar 

  42. Verghese A. A touch of sense. Health Aff. 2009;28(4):1177–82. https://doi.org/10.1377/HLTHAFF.28.4.1177.

    Article  Google Scholar 

  43. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020;20(1):1–9. https://doi.org/10.1186/S12889-020-09301-4/TABLES/1.

    Article  Google Scholar 

  44. Benziger CP, Huffman MD, Sweis RN, Stone NJ. The telehealth ten: a guide for a patient-assisted virtual physical examination. Am J Med. 2021;134(1):48. https://doi.org/10.1016/J.AMJMED.2020.06.015.

    Article  CAS  Google Scholar 

  45. Ansary AM, Martinez JN, Scott JD. The virtual physical exam in the 21st century. J Telemed Telecare. 2021;27(6):382–92. https://doi.org/10.1177/1357633X19878330.

    Article  Google Scholar 

  46. Centers for Disease Control and Prevention. Adult immunization schedule by vaccine and age group. 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Accessed 2 Jan 2022.

  47. National Foundation for Infectious Diseases. Call to action: adult vaccination saves lives. Bethesda; 2012. http://www.cdc.gov/vaccines/recs/schedules/default.htm. Accessed 2 Jan 2022.

  48. Centers for Disease Control and Prevention. COVID-19 vaccination clinical and professional resources. 2021. https://www.cdc.gov/vaccines/covid-19/index.html. Accessed 2 Jan 2022.

  49. Centers for Disease Control and Prevention. Human papillomavirus (HPV) ACIP vaccine recommendations. 2014. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html. Accessed 2 Jan 2022.

  50. Lu PJ, O’Halloran A, Ding H, Srivastav A, Williams WW. Uptake of influenza vaccination and missed opportunities among adults with high-risk conditions, United States, 2013. Am J Med. 2016;129(6):636.e1. https://doi.org/10.1016/J.AMJMED.2015.10.031.

    Article  Google Scholar 

  51. Lu PJ, Hung MC, Srivastav A, et al. Surveillance of vaccination coverage among adult populations—United States, 2018. MMWR Surveill Summ. 2021;70(3):1–26. https://doi.org/10.15585/mmwr.ss7003a1.

    Article  Google Scholar 

  52. Centers for Disease Control and Prevention. Adult immunization schedule by vaccine and age group. 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-compliant.html. Accessed 6 Feb 2022.

  53. Centers for Disease Control and Prevention. Recommended adult immunization schedule. 2021. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule-bw.pdf. Accessed 2 Jan 2022.

  54. Freedman MS, Ault K, Bernstein H. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older–United States, 2021. MMWR. 2021;70:9–19. https://doi.org/10.15585/MMWR.MM7006A2.

    Article  Google Scholar 

  55. Centers for Disease Control and Prevention. The adult vaccine assessment tool. 2021. https://www2.cdc.gov/nip/adultImmSched/. Accessed 2 Jan 2022.

  56. Pacheco J, Cuadrado C, Martínez-Gutiérrez MS. Urgent care centres reduce emergency department and primary care same-day visits: a natural experiment. Health Policy Plan. 2019;34(3):170–7. https://doi.org/10.1093/HEAPOL/CZZ023.

    Article  Google Scholar 

  57. Yee T, Lechner AE, Boukus ER. The surge in urgent care centers: emergency department alternative or costly convenience? Findings from HSC the rise of urgent care Centers. Cent Stud Heal Syst Chang. 2013;26:1–6.

    Google Scholar 

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Conigliaro, J., Kapoor, S. (2022). Screening/Physical Exam/Health Maintenance. In: Sydney, E., Weinstein, E., Rucker, L.M. (eds) Handbook of Outpatient Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-15353-2_1

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  • DOI: https://doi.org/10.1007/978-3-031-15353-2_1

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