The 35-45 Year Old Health Check – (Part 2)- The History


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By Murtaza Ahmed MD

Many people have come to think that the bulk of a health check consists of blood tests.  While blood tests are very important and have their role, they are by no means the be all and end all when it comes to deciding if you are healthy.  There are some Physicians out there who have become lazy and simply churn out forms for blood tests without first assessing the patient.  As well as being irresponsible, this can be potentially dangerous as people can go away thinking they have the all clear when really many issues weren’t even addressed.

A common term we use that dates back to the beginning of medicine is ‘the history’.  This is the most important part of any medical consultation and one should always begin with it.  It means taking a story via open and closed questions in order to gather all the necessary information we require.  History taking is a skill, and a well qualified Physician should be able to guide you into giving all the necessary information.  So what should you expect to be asked in a health check and why?

How are things going and do you have any particular concerns?

This will enable you to give a brief picture into how things are for you at the moment as well as allowing you to raise any particular concerns you have that you would like addressed.  This is important as it will guide your Physician as to the general path of the consult as well as make sure there will be time to address particular concerns you have.

Do you suffer from any previous medical issues and are you on any medications?

Also known as the ‘past medical’ and ‘past drug’ history, this information is vital in allowing you to be properly investigated and assessed.  If someone doesn’t ask you this they may be missing crucial information that will result in substandard care.  If you have a regular Physician they may not ask you as they are already aware but if you are visiting someone new then make sure you inform them of all your past medical issues.

Are there any diseases that are prevalent in your family?    

Also known as the ‘family history’, this allows your Physician to decide if any extra screening or investigations are required.  For example if there is a strong history of bowel cancer in your family it may be necessary that you undergo screening at an earlier age that the general population.  Make sure this is not overlooked!

 General review of all the body’s organ systems

This is referred to as a systems review and aims to quickly screen all the major organs to ensure there are no early signs of disease that need further questioning or investigation.  The main systems that should be enquired about are

Cardiovascular – Any chest pains, shortness of breath on exertion, palpitations etc

Respiratory – Any shortness of breath, chronic cough, wheeze etc

Gastrointestinal – Indigestion, bowel motions, abdominal pains

Urinary – Sexual health screen, erectile function, voiding issues

Gynecological – More specific to women – Abnormal bleeding, cervical cancer screening

Skin – Any lumps, bumps or rashes

These are the main systems but there will also be several other questions that you should  be asked.

Are you a smoker?  

Smoking is something that contributes significantly to the development of several diseases and is something that should be regularly addressed.  I always make the point to ask all my patients who smoke if they are thinking of quitting every time I see them.  Even if I know they don’t want to quit I still ask as one day they may surprise me and I want to be there ready to help them.

What is your alcohol intake?

Research has shown that people consistently underestimate their alcohol intake.  A good alcohol history involves being asked exactly how much and what drink you consume each night.  Sometimes just having to think about it and say it out loud is enough to make you realize you may be drinking too much!

What do you eat on a day to day basis?  

It is vital that you let your doctor know what you are eating and not just that you think you have a healthy diet.  I see countless people who think they are on a healthy diet but are actually consuming foods that are detrimental to their health on a regular basis.  A health check is the perfect opportunity to pick up these problems and offer advice as to how to maintain a healthy diet.

Do you partake in any physical activity?

Your physical activity levels will also be ascertained as if you are not doing enough exercise your risk of cardiovascular disease may be higher and so need more attention.  If someone is not exercising I always make a point of asking why.  This isn’t so I can make them feel bad but instead so I can offer a solution if there are any particular limitations I can offer help with.

Are you happy or is there anything bothering you?

A large proportion of the population suffer from some form of mental illness and a scarily significant portion of these remain undiagnosed.  Depression, anxiety and other issues can affect anyone at any point in their life and can be significantly disabling.  Many people will not ask for help as they are scared of being judged or think they can’t be helped.  If you have any symptoms or concerns regarding mental health be sure to raise them with your doctor as there are so many ways in which we can help you and you do not need to suffer in silence.

There are several questions your Physician should ask you before they even lift up a stethoscope or pump up a blood pressure cuff.  This information is of vital importance and you should be forthcoming in all your answers.  I hope now you have a good idea of what you should expect to be asked and you could probably even think about these issues beforehand so you can answer in more detail.  If you feel that some of the information has been missed or not been enquired about during your health check, feel free to mention it or ask that it is explored.  After all it is your health that is being checked!

Once your Physician has taken a good history and listened to all your concerns, it is time to move on to the ‘physical exam and ordering of investigations’

 

About Murtaza Ahmed MD

Dr Murtaza Ahmed is a General Practitioner sub-specializing in the field of Sports, Exercise and Nutritional Medicine. He graduated from The University of Nottingham, England, and in addition to his medical qualification he holds a Masters in Sports and Exercise Medicine (MSc), Bachelor of Medical Sciences (BMedSci) and Membership of the Royal College of Physicians (MRCP London).
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