Routine physical examination template

The routine physical examination template that is most suitable for ordinary healthy people is essentially "1 set of basic required items + N personalized risk items". There is no unified universal list. Young people aged 18-35 without underlying diseases will spend 300-800 yuan for a complete set. High-risk people over 40 years old will not need to spend more than 2,000 yuan at most. Most of the extra items are IQ taxes. If you miss the corresponding high-risk items, your trip will be in vain.

A while ago, I helped my cousin who had just joined the job choose a physical examination package, and I checked out more than 20 popular packages on a certain platform. They were either the 199 yuan "beggar's package" that only checked two items of liver function, or the 3,999 yuan "luxury package" that included a bunch of genetic tests, a full set of tumor markers, and even some trace element tests. It was a complete rip-off of people.

You don’t have to work hard to collect the basic items by yourself. Just go to a public tertiary-level physical examination center. The cheapest basic package will already have everything you need: basic physical signs such as height, weight and blood pressure, blood routine, liver and kidney function (try to choose all items, which is only a few dozen dollars more), fasting blood sugar, four blood lipid items, urine routine, plus abdominal ultrasound (liver, gallbladder, pancreas, spleen and kidneys), ordinary electrocardiogram, and routine medical and surgical palpation. These are enough to screen out most common basic problems.

When it comes to imaging examinations, there is quite a quarrel on the Internet. Some people say that chest X-rays should have been eliminated long ago, and that all physical examinations should be performed directly with low-dose CT. In fact, there have always been two opinions in the industry: Most radiology doctors believe that for people under 35 years old, with no family history of lung cancer, non-smokers, and long-term exposure to second-hand smoke/kitchen fume, the radiation benefit ratio of annual CT is not high. Ordinary chest X-rays are enough to screen out obvious pulmonary nodules, pneumonia, and thoracic deformities.； However, thoracic surgeons prefer to do low-dose CT as long as they have the conditions, and those over 30 years old can do low-dose CT. The accuracy of early screening is much higher. There is no absolute right or wrong, just choose according to your own risk profile, and don’t be anxious about the arguments from both sides.

Last year, a 31-year-old female reader complained to me, saying that she spent more than 2,000 on a physical examination every year, but this year she was diagnosed with mid-stage breast cancer. When I looked at her previous physical examination sheet, I found that she had never had a breast ultrasound. All the money was spent on "female anti-cancer gene testing", which is really a pity. In fact, for women, if they add HPV + TCT to screen for cervical cancer every year after the age of 25, and add a breast ultrasound after the age of 30, the two together only cost more than 300 yuan, which is more useful than any flashy items.

If there are male elders in the family, I would like to remind you that if you are over 40 years old and have a history of smoking, don’t worry about the two or three hundred dollars. Just replace the chest X-ray with a low-dose CT and add a PSA to check for prostate cancer. My uncle has been a smoker for 22 years. He had been doing chest X-rays for the past few years and nothing could be seen. The year before last, he changed my case to CT, and a 3mm ground glass nodule was found. Now he has a follow-up visit every six months. At least he has an idea. He will not wait until symptoms appear to find out that it is in the late stage.

There are also many people who ask whether to do a complete set of tumor markers. This is also very controversial: one school of thought is that there is no need to do routine physical examinations because the false positive rate is too high. If you stayed up late the day before, drank alcohol, or even had a cold and inflammation, the indicators will be high. In the end, you will be scared to death and then do a bunch of tests. There will be no problems. It is a pure waste of money.； The other group believes that if you have a family history of cancer, you can add 1-2 items in a targeted manner. For example, if you have a family history of liver cancer, add alpha-fetoprotein AFP, and if you have a family history of digestive tract cancer, add carcinoembryonic antigen (CEA). There is no need to do a full set of more than a dozen items, which is useless.

Really don’t touch these IQ taxes: “One drop of blood can detect cancer throughout the body”, “Genetic testing can detect obesity/talent”, “Whole-body PET-CT should be used as a routine physical examination”. I once met a boss who made building materials. He spent 18,000 on PET-CT every year as a routine physical examination. Later, he went to our hospital to see the old director of the radiology department to see the film. The old director scolded him, saying that PET-CT is used for staging and finding metastases in patients who are already suspected of cancer. The radiation dose of a healthy person is equivalent to 10 consecutive CT scans. It is completely unnecessary. If we really want to prevent cancer, it is better to implement the targeted early screening program mentioned above than anything else.

Finally, a practical reminder: don’t eat hazelnuts three days before the physical examination. One of my colleagues drank three bottles of beer with friends the night before. The next day, his transaminase was three times higher than the normal value. He thought he had hepatitis. He cried at home for several days and took a week off to go for a reexamination. Nothing happened, so he was suffering in vain. Also, physical examinations for girls must avoid menstrual periods, otherwise the urine routine will be full of red blood cells, and the results will be impossible to refer to, and you will have to make another trip.

To be honest, routine physical examinations are never more expensive, and there is no perfect list that suits everyone. If you are really not sure what items to add, just spend 5 yuan to call the regular number of the physical examination department, tell the doctor your age, whether you have a family history, whether you smoke or not, and whether you have any discomfort in daily life, and let the doctor adjust it for you. It is much better than blindly buying from an online list or listening to salesmen and adding a bunch of useless items.