Routine physical examination and re-examination

Routine physical examinations are required to be re-examined. More than 90% of them are not early warnings of major diseases. Most of them are due to sample deviations, transient physiological abnormalities, detection thresholds, and non-disease fluctuations. The initial screening results are doubtful. The probability of a final diagnosis of malignant lesions is less than 2%. There is no need to scare yourself first.

Last month, I accompanied my mother to get the physical examination report. The doctor pointed to the alpha-fetoprotein column and said it was too high, and suggested retesting after three days on an empty stomach. She turned pale on the spot and didn’t even buy groceries when she got home. She squatted on the sofa all afternoon and searched for early symptoms of liver cancer. She even privately murmured with my father for half the night about how to divide the inheritance. It turned out that the day before the re-examination, she was so nervous that she had insomnia and drank half a glass of white wine to calm down the shock. The result was higher than last time. Later, I forced her to eat lightly and not dance in the square. I checked again on the third day and the value returned to the normal range. Only then did I remember that three days before the physical examination, she had a dinner with her old best friend, ate braised pork liver, and danced for two hours in a row until her muscles were damaged, which would have affected this indicator.

It’s interesting to say that most of the people around me who treat the re-examination as a notice of terminal illness are people who don’t usually do physical examinations. Instead, they have regular physical examinations every year. When they see the re-examination notice, their first reaction is “Oh, I stayed up late again last time.” Many people don’t know that the reference value on the physical examination report is actually the value range of 95% of healthy people, and 5% of healthy people are born outside this range. For example, the reference value of uric acid is generally classified as 420 μmol/L. If you find out 425, the doctor will definitely ask you to re-examine. It does not mean that you have gout, or just stepped on the boundary, and you have to rule out whether you ate hot pot seafood and drank cold beer the day before.

Of course, there are also people who think the other way around is that the hospital wants to make money by asking for reexamination. This view is quite extreme. A public tertiary-level radiologist I know said privately that when they write a report now, they would rather ask you to go for another re-examination than casually conclude that "no abnormality is found" - after all, the physical examination is a preliminary screening, and the responsibility is too heavy. He saw a 3mm on the chest X-ray before. For micro-nodules, the guidelines originally allowed for "annual follow-up", but he still asked the patient to re-examine three months later. It turned out that the patient really had very early-stage lung cancer. After the surgery, he didn't even need to undergo chemotherapy. If he hadn't mentioned the re-examination at that time, it would have been in the mid-to-late stage after a year. Of course, it is not ruled out that some private medical examination institutions intentionally set the threshold in order to increase revenue and ask you to do more high-premium examinations. In this case, you can take the report to a public tertiary institution and call a regular number and ask, and the cost is only ten yuan in registration fees.

Different re-examination requirements actually point to completely different possibilities. Don’t get nervous as soon as you hear that you are asked to do additional projects. If you are only asked to "check your blood again on an empty stomach", most of the abnormalities will be in liver function, kidney function, blood sugar and blood lipids, which are greatly affected by diet and rest. If you adjust it for a few days, it will basically be fine. ； If you are asked to "change the instrument and check the ultrasound again", it is most likely that there was too much intestinal gas in your stomach during the last check, which blocked the gallbladder or pancreas. The doctor could not see clearly, so it was not a growth. ； If you really want to do a CT or MRI, don’t panic. Most of the time, the image of a certain part has a blurred shadow, which needs to be confirmed by a higher-precision instrument. In many cases, it is inflammation, calcification, or benign nodules.

Of course, I’m not telling you not to take the re-examination seriously at all. There are quite a few people who don’t take the re-examination seriously. Uncle Zhang, who lives downstairs in my house, had a physical examination last year and found positive for occult blood in his stool. The doctor asked him to do a colonoscopy. He patted his chest and said that he had old hemorrhoids that he would never get rid of. This year, he had severe blood in his stool before he went for a check-up. He was already in the middle stage of rectal cancer and suffered the biggest sin.

In fact, to put it bluntly, a physical examination is equivalent to an "annual examination" of the body. A re-examination is just a matter of taking a closer look at a part that you just scanned and didn't see clearly. There is no need to start making a will as soon as you receive the call for re-examination, and don’t be so anxious that you just stuff the re-examination form in the drawer to collect dust. Adjust your work, rest and diet in advance according to the time prescribed by the doctor, and go when you need to. What a big deal.