Health Screening and Risk Assessment
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.
Our 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 healthy?
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 care physician:
- 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 becomes severe.
In 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.
However, screening guidelines can vary from one medical association to another.
They 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:
United 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.
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 system.
- Pneumococcal vaccine (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 years.
- Tetanus-diphtheria 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.
- 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.
- 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.
Note: 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 are planning to become pregnant.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/ This document was last reviewed on: 5/15/1998