HEALTH SCREENING & RISK ASSESSMENT
We Recommend ALL our women patients to also see a GYN to get their
annuals including Pap testing , and Breast exam with them as these are not
offered at our practice.
What is the role of the primary care provider?
Your primary care provider is usually
an internal medicine physician whose task is to assist you in preventing
disease and maintaining your health. An internist is by definition a
diagnostician, a person who attempts to identify the cause of your symptoms.
patients range from adolescents to the elderly. Our task is to prevent,
diagnose, and treat diseases primarily affecting adults. We care for the whole
patient. We bring to patients an understanding of wellness (disease prevention
and the promotion of health) as well as effective treatment of multiple medical
problems of any organ system.
How can my primary care provider help me to stay
Two important ways your primary
care physician can help you maintain your health are by assessing your risk for
disease and performing routine health screenings.
Health risk assessment
A health risk assessment is completed by gathering information
about your health and medical history. To complete the assessment, your primary
Asks you to describe any
medical problems you are having.
Obtains a history of any
of your past medical problems and surgeries.
Reviews your family's
history of illnesses, which can play a role in your health.
Routine health screenings
Health screenings are tests or physical
exams that are used to assess your health. These screenings can help your
primary care provider identify problems early, before an illness develops or
general, physicians recommend health screenings based on guidelines developed
by the United States Preventive Services Task Force (USPSTF). These guidelines
are tailored to the specific behaviors and risk factors of each patient and are
considered the "gold standard" by physicians.
screening guidelines can vary from one medical association to another.
also can depend on your medical history and risk factors. You can follow the
screening guidelines described in this handout as a starting point. Your
primary care physician can also help you develop a screening schedule tailored
to your needs.
Organizations that promote screening guidelines
include the following:
States Preventive Services Task Force (USPSTF)
American Medical Association (AMA)
American College of Physicians (ACP)
American Academy of Family Practitioners (AAFP)
American College of Cardiology (ACC)
American Heart Association (AHA)
American Cancer Society (ACS)
American Diabetes Association (ADA)
Guidelines for preventive intervention
Routine visits: Vary according to the patient's
age, gender, risk factors, and health problems.
Risk factors include
hypertension, elevated cholesterol, diabetes and cigarette smoking. The USPSTF
does not recommend routine electrocardiograms (EKG). The AAFP suggests a baseline
EKG for men 40 and older with 2 or more cardiac risk factors, or for sedentary
men about to start an exercise program. The ACC advises baseline EKG for men
and for women 40 and older, or for those about to undergo an exercise stress
test. Risk factors include cigarette smoking, hypertension, diabetes, obesity,
and family history of coronary artery disease or high cholesterol. The USPSTF
recommends periodic cholesterol testing in men 35 to 65 years of age and women
45 to 65 years of age, but not in persons over 65. The ACP recommends
cholesterol testing in every patient every 5 years after the age of 20.
Risk factors include cigarette
smoking, hypertension, diabetes, obesity, and family history of coronary artery
disease or high cholesterol. The USPSTF recommends periodic cholesterol testing
in men aged 35 to 65 and women aged 45 to 65, but not in persons over 65. The
ACP recommends cholesterol testing in every patient, every 5 years after the
age of 20.
Hypertension is defined as
systolic blood pressure of 140 mm Hg or diastolic blood pressure of 90 mm Hg.
The USPSTF recommends measuring blood pressure in all adults. Once hypertension
is confirmed, then the physician counsels patients on diet, exercise, weight
reduction, sodium intake, and alcohol intake. The AHA advises regular blood
pressure testing at least every 2 years in patients with normal blood pressure,
every year for borderline blood pressure (130-139/ 85-89), and more frequently
for high blood pressure.
High risk women are those with a
family history of breast cancer and those who have not had a child before age
30. The USPSTF calls for routine screening every 1 to 2 years with mammography
and yearly clinical breast exam for all women 50 to 69 years of age. It has not
found evidence to recommend routine exams for women under 50 years of age or 70
years of age and older. The AMA and ACS recommend annual clinical breast exam
and mammography every 1 to 2 years beginning at age 40 and every year beginning
at age 50. They also advocate women doing monthly breast self-exams.
Risk factors include family
history of hereditary syndromes associated with colon cancer, personal history of
polyps, and inflammatory bowel disease. The USPSTF recommends annual fecal
occult blood testing, and sigmoidoscopy
every 3 to 5 years for everyone age 50 and older. The AAFP recommends annual
fecal occult blood testing, and sigmoidoscopy, or
barium enema routinely for people 40 years of age and older if there are risk
factors. The ACS suggests annual occult blood testing and sigmoidoscopy
every 5 years or colonoscopy every 10 years in people 50 years of age or older.
They also suggest colonoscopy every 3 years for people with high risk. There
are no recommendations given for people 70 years of age and older.
Cervical cancer (Dr.Raya does not do pelvic exams or
pap tests and recommends his female patients to see a Gynecologist)
Risk factors for cervical cancer
include family history, early onset of sexual activity, history of multiple
partners, and HIV infection. All women who are or have been sexually active and
who have a cervix should have routine Pap smears. Testing should begin at the
onset of sexual activity and be repeated at least every 1 to 3 years, based on
risk factors for cancer. Pap smears are not useful after a hysterectomy, if it
was not done for cancer. The ACS, AMA, and AAFP suggest testing every year in
women with risk factors, and every 3 years in women with no risk factors who
have 3 consecutive normal Pap smears. There are no suggestions given for women
over 65 years of age.
Risk factors include family
history and being of African American descent. The USPSTP and AAFP do not
recommend routine screening for prostate cancer because of the lack of evidence
that it decreases morbidity (disease) or mortality. The ACS, however,
recommends annual digital rectal exams for prostate cancer beginning at age 40
and an annual blood prostate specific antigen test (PSA) beginning at age 50.
They recommend men with risk factors start both tests at age 40.
Risk factors include family
history, obesity, and older age. According to the ADA, diabetes is diagnosed
when a person's blood glucose level is 126 mg/dl or higher during a fasting
blood glucose test. The USPSTF does not recommend screening patients with no
symptoms and no risk factors. The ADA suggests that all adults be screened for
diabetes every 3 years beginning at age 45. Those with risk factors should be
tested more often.
Risk factors include a family or
personal history of depression, those with chronic illnesses, those who have
experienced a recent loss, and those with sleep disorders, chronic pain, or
multiple unexplained complaints. There are no clear guidelines given here and
no standardized testing that is recommended. The AAFP and AMA recommend that
physicians be aware of symptoms.
Influenza vaccine (flu shot)
is recommended annually for all patients 65 years of age and older and for high
risk patients with diabetes, asthma, chronic illness, or a compromised immune
(pneumonia shot) is recommended for all patients 65 years of age and older and
for all high risk patients as listed above. This vaccine is given every 6
vaccine is recommended for all adults who never received one and a booster is
recommended every 10 years or after 5 years if the person is at risk of
exposure to tetanus. Patients are recommended to get this immunization at the
Local Health Department.
Measles and mumps
vaccine should be given to all those born after 1956 who have no immunity
against these illnesses. A second measles vaccine is recommended for
adolescents and young adults. Patients are recommended to get this immunization
at the Local Health Department.
Hepatitis B vaccine
should be given to adolescents and young adults if not already done, and to
high risk groups, including health care workers, travelers to endemic areas, IV
drug users and their sexual partners, and homosexuals.
Measles, mumps, rubella, polio and chickenpox vaccines are not safe for
pregnant women. Tetanus, diphtheria, pneumoccocal and
influenza vaccines can be given safely during pregnancy. Inform your physician
if you are pregnant or are planning to become pregnant.