“Doctor, I’ve

come for a check

up!”

Presented by
Felicity Cheng
C3307612
Case presentation
• 73 Y.O. female Mrs X who presented to have a ”check-up” with the doctor
after bumping into him in a local shopping centre. Doctor hadn’t seen her
since she had last seen him when she gave birth to her first child

• Complained of a history of mild arthritis which she managed with

paracetamol

• Hadn’t been to a doctor in over 30 years

Why would a patient present for a
check up?
Because…
• They have a hidden agenda?
So… if you’re feeling
• They haven’t seen a doctor in a while? fine… why are you
• They have been educated that it’s good for them? here??
• They are on medications and want to know if
they’re still needed?
• They know that screening is good prevention for
future disease?
• They miss seeing their doctor?

• Make up 1.9% of all presentations to a doctor,

being the 7th most common problem in Australia`1
What are the guidelines?3
Guidelines Dr asked? Why are you
asking me this??
Ask about SNAP Yes
Screen possible depression No
Early signs of skin cancer No
Ask about family history Yes
Measure weight and height, WC Yes I need to check up
on your health.
Measure blood pressure Yes
Measure fasting lipids No
Pap Smear No
Mammogram No But I came in for a
prescription, not to
Risk of diabetes No
be quizzed on my
Osteoporosis screen/fractures risk No smoking!!
Absolute cardiovascular risk Yes
What are the potential benefits and
harms of a checkup ? 4,5
Benefits
- Health checks lead to a 20%
increase in the total of new
diagnoses per participant over 6
years
- Lead to an increased use of
antihypertensives
- Small beneficial effects on self
reported health (bias?)
- Risk assessment and screening
- Update vaccinations
- Builds good rapport between
patient and doctor
Harms
- False positives - unwarranted
stress
- Over-diagnosis – you’re going to die
anyway – not worth the emotional,
financial and physical pain to go
through treatment
- Focused checkup vs. full write ups
- No overall difference in
cardiovascular mortality 5
- Over testing and financial drain on
system
- Findings of uncertain clinical
importance
Who avoids checkups?
• Aboriginal populations

• Young populations

• Middle aged populations

• People who smoke, have bad diets and physical exercise

• People with health conditions that prevent them from going e.g. depression, anxiety, MS

• People in low SES communities

 Uneducated
 Need to work a lot
 Busy with family obligations
 No health insurance

• People who feel healthy

• People wo don’t have access to health care

• People for whom there is a language barrier

• Traumatised populations due to communication concerns

• Abusers
References
• 1. Cooke G, Valenti L, Glasziou P, Britt H. Common general practice
presentations and publication frequency. Australian Family Physician.
2013;42(1):65-68.
• 2. Tam C, Zwar N, Hespe C. Patients' acceptance of SNAP assessment: An
exploration. Australian Family Physician. 2016;45(5):340-341.
• 3. The Royal Australian College of General Practitioners. Guidelines for
preventive activities in general practice. 9th edn. East Melbourne, Vic:
RACGP, 2016.
• 4. Birtwhistle R, Bell N, Thombs B, Grad R, Dickinson J. Periodic preventive
health visits: a more appropriate approach to delivering preventive services.
Canadian Family Physician. 2017;63(11):824-826.
• 5. Ewald B, Del Mar C, Hoffman T. Quantifying the benefits and harms of
various preventive health activities. Australian Journal for General
Practictioners. 2018;47(12):842-845.