Routine physical examination items

The core fixed items of routine physical examination are usually divided into three categories: basic physical examination, laboratory tests, and functional and imaging examinations. It is enough for healthy adults without underlying diseases to do the basic items covered by these three categories, and there is no need to blindly add items.

When you first enter a physical examination center, the first thing you do is usually a basic physical examination, which is nothing more than measuring height, weight, blood pressure and heart rate. Then you go to the internal medicine, surgical, otolaryngology, and ophthalmology clinics one by one. The doctor massages the stomach, feels the thyroid gland, and looks at the fundus of the ear canal. Don't think that these items are "processes". I accompanied my mother for a physical examination before. She hurriedly took blood for a routine blood test. After running two steps to measure her blood pressure, it shot up to 142. The nurse stopped her and made her sit for ten minutes before taking another test before it returned to normal. She was reminded on the spot not to walk too fast to rush for time. Too much fluctuation is bad for blood vessels. There are also many people who feel that their weight is accurate and they do not need to measure their abdominal circumference to calculate their BMI. Last year, a male colleague at work had a BMI of 28.7 and said that he was just "strong". It was not until the medical examiner pointed to his 89 cm abdominal circumference that his risk of metabolic syndrome was 2.4 times higher than that of a person of normal weight, so he started to control his diet. Of course, many people have suggested that this kind of basic examination can be done at home, and there is no need to waste physical examination quotas. Now many private medical examination institutions are indeed trying to change such items to self-filling. At present, the industry has not yet formed a unified standard, and each has its own considerations.

After handing in the basic examination form, what everyone is most worried about is the blood drawing window. This part is the core content of the laboratory test. The three or four tubes of blood drawn in the routine items usually check the four items of blood routine, liver and kidney function, fasting blood sugar, and blood lipids, plus the urine sample, stool sample, and stool routine, and there are no other unnecessary items. There was a friend who always thought that it was good to have blood drawn every year. He wanted to skip it last year, but I forced him to do it. It was found that the lymphocytes were abnormally elevated. Further tests revealed that it was an insidious Epstein-Barr virus infection. He took the medicine in time and did not develop myocarditis. It was considered a small trouble. There is another point that has been controversial for a long time: Are tumor markers considered routine items? One group thinks that adding two common alpha-fetoproteins and carcinoembryonic antigen will only cost tens of dollars more, and can provide early warning of the risk of liver cancer and gastric cancer. ； The other group believes that healthy young people are prone to anxiety due to false positive results. Now the general consensus in the industry is that people over 40 years old or with a family history of cancer can be added. Healthy people aged 20-30 do not need to be included in the routine. Projects in different regions will also be adjusted. For example, my hometown is an area with a high incidence of gastric cancer. The local public physical examination center directly adds Helicobacter pylori breath test to the routine projects. This is one more item than other places. These are reasonable adjustments that meet local needs.

After drawing blood and drinking water, the next step is to go to the imaging and functional examination clinic. The conventional ones are electrocardiogram, chest X-ray, and abdominal ultrasound of the liver, gallbladder, pancreas, spleen, and kidneys. For women, an ultrasound of the breast and uterine appendages will be added, and for men, a prostate ultrasound. Last year, three thyroid nodules and two gallbladder polyps were found during the physical examination at work. They were not noticeable at all, so follow-up was enough. It would be troublesome to wait for symptoms to appear. The most controversial issue in this department recently is whether to replace chest X-rays with low-dose spiral CT for routine physical examinations. Some people think that CT radiation is greater than that of chest X-rays, and chest X-rays are enough for healthy young people. ； Some people also think that the age of onset of lung cancer is getting earlier and earlier, so it is better to get it right in one step. The current recommendation is that people under the age of 40 with no history of smoking and no family history of lung cancer are enough to have chest X-rays, and it is safer for the remaining high-risk groups to directly switch to low-dose spiral CT.

I have been a volunteer at a community physical examination center for almost two years, and I have seen too many people ask if they want high-end projects worth several thousand yuan upon arrival, such as whole-body tumor screening, genetic testing, and PET-CT. It is really unnecessary. There was a young man who had just started working. The regular package of more than 300 yuan was enough for him, but he insisted on adding more than 2,000 yuan for a cancer gene test. The final report came out and said that his risk of gastric cancer was 30% higher than that of ordinary people. He was so scared that he had insomnia for half a month. There was nothing wrong with the gastroscopy. It was simply a waste of money.

Oh, by the way, there are also some routine adjustments for specific groups of people. Girls who are over 21 years old should add TCT and HPV tests to their routine physical examinations. People who smoke all year round should have their lung function checked more often. Patients with diabetes should also include glycated hemoglobin in the routine items. These are all things that cost a small amount of money and save big troubles. You don’t need to listen to salesmen and buy those fancy packages. If you complete the basic items, you can handle 90% of early disease screenings.