What is a Physical

A physical is a once yearly review of your overall health; it is NOT a problem based visit where multiple new issues will be brought up or addressed. You should be feeling overall healthy and ready for a comprehensive review of your health over the course of the year. Generally, if you are healthy without ANY medical issues or medication that need management, a once a year visit for the following lab work and physical exam is more than comprehensive. Physicals ALSO include a well woman exam/pap smear/breast exam that should be done on a separate appointment. A regular physical AND female well exam should NOT be combined (You get two! Use em!); your insurance will likely not pay for both on the same visit and there is equipment/rooms that need to be used for a proper well woman exam

Obviously new issues do arise and we attempt to address them, but insurance companies will likely NOT cover additional testing/imaging other than what is stated below. For instance; you should not be expecting to get a physical and an order for an MRI for your right shoulder pain without paying through the nose for it. All of our recommended lab-work is NOT always covered by insurance and it is your responsibility to understand how your insurance works; every plan is not equal and it is impossible for your physician to know what will be covered and not; they know what you need. We realize this is frustrating; we hate it too:     

                Labs included in your physical based on our recommendations:

1.       CBC-Checks for infection/anemia, overall bone marrow health

2.       CMP-Checks Liver/Kidney function

3.       TSH-Thyroid function

4.       Lipid Panel-Cholesterol/LDL/HDL/Triglycerides

5.       Hemoglobin A1C: Checks for diabetes/Pre-diabetes

6.       +/- STI Testing

·         HIV-Checks for HIV

·         RPR-Checks for Syphilis

·         Gonorrhea/Chlamydia in the sites you use for sex (Mouth/Throat, Urine, Vagina, Rectum)

***labs generally NOT covered for yearly physicals (this is not a comprehensive list and may or may not apply to you and you should check with your insurance BEFORE we order them so you do not get stuck with a bill***

TSH

Hemoglobin A1C

Gonorrhea and Chlamydia swabs for Vagina/Rectum/Throat/Mouth

Any Vitamin Check (B12/CoQ10/VitD)

ANY hormone check (Estrogen/Testosterone)

Age Based Cancer and Preventative Health Screening Addressed at Yearly Physicals

Pap Smear/Cervical Cancer Screening

·         Starting at 21 until age 65 if previous two paps are normal; if they are normal every 3-5 years follow-up is appropriate

·         ANY post menopausal bleeding of any kind needs to be promptly followed up with OBGYN

·         You should ALWAYS have a yearly inspection of your genitalia; this does not necessarily mean you need a Pap smear

Mammogram/Breast Cancer Screening

·         Yearly starting at 40-75 if they are normal without any family history of early breast cancer. Appropriate follow-up is based on mammogram findings

·         If you are under the age of 40 and feel that you have changes in your breasts, we will individualize your cancer screening with you

Prostate Cancer Screening

·         This is individualized for every patient; current guidelines do NOT recommend frequent PSA screening without family history of early prostate cancer. This will be an individualized conversation depending on your needs

Colon Cancer screening

·         Starting at 45-75 if there is no family history of colon cancer or significant change in bowel habits (ie blood in stool, new constipation/diarrhea/change in stool diameter)

·         We prefer the gold standard screening which is an actual Colonoscopy which requires a referral to a gastroenterologist

Lung Cancer Screening

·         IF you were a former smoker/current smoker, who has smoked a pack a day for more than 30 years, and are between the ages of 55-80; yearly low dose Cat scan of the lungs is recommended.

Age Based Recommended Vaccines (NOT ALL ARE COVERED BY INSURANCE; PLEASE CHECK WITH YOUR INSURANCE)

·         Yearly Flu Shot: Don’t be a dummy, get your flu shot

·         Shingrix: Two doses, starting at age 50-65; to prevent shingles

·         TdAP/Boostrix: Every 10 years for Tetanus/Diptheria/Pertussis protection

·         Pneumococcal: Ages 19-64 with certain health problems, any adult above 65; two shots, “Pneumonia shot”

·         Meningococcal: Entering College (age 17), Populations at higher risk (HIV, MSM, Military etc) every 5 years

·         Hepatitis: A/B: All PrEP/HIV patients should be immunized to Hep A and B, and checked regularly for immunity

·         HPV: any sexually active adult until the age of 45; you can still get after 45 by likelihood of coverage is very low

Problem Based Visit

This is the majority of visits to the doctors office; ie cough, back pain, painful urination, “I just wanna check some stuff and I’m having trouble sleeping but also want this vitamin checked and my hormones”. These are all problem based visits and are NOT part of a routine physical.

After you make an appointment, the front desk always (or should) tell you the amount of time that you have with the doctor; ie a 15 minute appointment, 30 minute appointment, or even 45 minute appointment if you feel that you need one.

You have to show up EARLY to your appointment; you will always have some form of paperwork to fill out, and especially with COVID you have multiple temperature point checks and extra questions to answer to ensure safety for yourself and others. If you are late for your appointment, you have forfeited your appointment time and will have to wait for the next available appointment or reschedule. Please call the office.

If you know that you will have multiple issues to address, it is in your best interest to request a longer appointment. It is impossible to address every issue adequately if we do not have enough time to explore each issue. Something that you feel might be an oversight or simple usually takes much more time to handle to ensure you get the best care possible.

Common Problem Based Visits and appropriate follow-up

HIV Care

Generally we have to see you every 3 months, especially if you are early in the course of treatment. After 2 years of stabilized treatment and maintaining an undetectable status, it is possible, depending on the provider you are seeing, to extend visits to every 6 months. This is individualized to each patient and provider.

PrEP/STI Screening

We have to see you every 3 months for blood work and STI testing. If you cannot commit to this frequent of followup then PrEP is not for you

Hormone Replacement (Testosterone/Menopause)

We have to see you every 3 months for blood work; ideally before the afternoon for more accurate hormone panels

Often, a known and common side effect is polycythemia (increased blood counts) which will either require you to stop taking your testosterone for 2 weeks, and come back in for a repeat CBC, or that you will need blood letting/phlebotomy (this is not covered by insurance). If you cannot commit to this then hormone replacement is not for you.

Hypertension

Every 3-6 months depending on your other co-morbidities (other medical conditions).

Hyperlipidemia (high cholesterol)

FASTING labs every 3-6 months depending on your other co-morbidities  

Depression/Anxiety/Insomnia

Every 3 months; at a minimum. You can choose to follow-up more frequently if you feel that our encounters are helping you to manage and cope during these times as well. We are not licensed therapists, but we do deal with depression/anxiety/insomnia every single day. We are here for you <3

Diabetes 

FASTING labs every 3 months; we HAVE to check your Hemoglobin A1C this often, check for protein in your urine, and check your Lipids (Cholesterol).

Every year you must also complete

1)      Ophthalmology for a dilated retinal exam; diabetes can cause damage to your retina leading to blindness.

2)      Podiatry for monofilament testing to see if you have intact nerve sensation, and also to check for any cuts/infections

Optional: Nephrology: If you start to spill out protein into your urine, your provider may request you to see a nephrologist to also establish care. It is very common for diabetics to develop kidney issues and eventually need dialysis. This does not happen to everyone, but is also why it is important to maintain 3 month follow-up with us so that we can catch this early and give appropriate recommendations.

Not completing these recommended screenings only places you at higher risk for developing complications such as blindness, or possible amputations. Now that does not sound cute to me.

Pain Management/ADHD/Any controlled substance

Often, because of DEA regulation you need to follow up monthly with the physician that is prescribing these medications. You will have random drug screens (urine, or blood) and they will not be announced. You will have your prescription history double checked on a database to make sure that you are due for your refills; we will not be able to refill your medication if you still have days left on your previous one; not only are we violating federal law but the pharmacy checks the same database and will not fill your prescription either.

***This is not a complete list of issues that we treat or all recommendations. You should always ask your provider what the appropriate follow-up will be if we were not clear during your appointment as we individualize our treatment for each patient. This is a list to help you help yourself have a better experience with us or any doctor that you see in the future***