What items are checked in a routine physical examination?

There is no completely unified fixed list for routine physical examination. The core is a combination of "basic must-do items + personalized adjustment items". The basic items cover most common health risks, and the adjustment items are increased or decreased based on the individual's age, occupation, past medical history, and family history.

I have been working as a consultant and coordinator in a public physical examination center for 5 years, and the most common question I encountered was "What should be checked in a routine physical examination?" Many people want to find a "standard package that is common to everyone" when they come here. There is really no such thing. The basic recommended items for adults given by the National Health Commission are actually very simple. They are the commonly mentioned general examinations of height, weight and blood pressure, plus routine blood and urine tests, liver and kidney function, fasting blood sugar, blood lipids, chest X-ray, electrocardiogram, liver, spleen, kidney and abdominal ultrasound. These total only two to three hundred yuan, which is basically enough for young people with no special circumstances.

Last week, I met a 27-year-old Internet operator girl. I originally wanted to choose the cheapest basic package. I asked her a few words and found out that she stayed up until two or three o'clock all year round. Her aunt only came once every two or three months. Both her grandmother and mother had thyroid cancer. So I persuaded her to add a thyroid ultrasound and six sex hormones. The result was found to be thyroid nodule 4a. Fortunately, the follow-up puncture was benign. Regular reexamination will be done according to the doctor's instructions. If you only do the basic items, you will most likely miss this problem.

What everyone is arguing about now is whether to add CT to routine physical examination and whether to check a full set of tumor markers. There is really no standard answer to these two questions. For example, when it comes to CT, one school of thought believes that people under the age of 35 who do not have high-risk factors such as smoking or family history of lung cancer should take a chest X-ray and there is no need to bear the radiation of CT. The other school of thought believes that lung cancer is getting younger and younger. Even if there are no high-risk factors, it is safer to do a low-dose spiral CT every two or three years. In the case I encountered myself, last year there was a 41-year-old smoker who changed his chest X-ray to a low-dose CT after listening to the doctor’s advice. An 8mm ground-glass nodule was found. He was diagnosed with early-stage lung cancer and recovered very well. Such a small nodule is basically invisible if a chest X-ray is taken.

As for the full set of tumor markers, there is no need to blindly select them. Many people check all the more than a dozen items at the beginning, thinking that the more complete the check, the more secure they will be. In fact, ordinary healthy people can only choose the two basic items of alpha-fetoprotein and carcinoembryonic antigen. The rest are targeted at specific groups of people. For example, prostate-specific antigen is used to screen for prostate cancer in men over 50 years old, and CA125 is prepared for women with a family history of ovarian cancer. Random checks can easily increase anxiety. Last month, there was a 32-year-old young man who had a full set of tumor markers. It was found that his CA199 was a little high. He was so panicked that he didn't sleep well for a week. After a follow-up examination, he found out that the trouble was caused by a butter hot pot meal with a friend the day before the physical examination. It was nothing.

Oh, by the way, there are also examinations in small departments such as ophthalmology and otolaryngology that many people will automatically skip, so don’t throw them away easily. My mother thought it was troublesome to have her eyes checked last year, so she wanted to skip it, but I forced her to do it. As a result, microaneurysm was found in the fundus of her eyes. After further examination, I found out that she has been suffering from latent diabetes for almost two years. She didn't have any symptoms of thirst or weight loss before, but she was able to control it if she found out early. Now her indicators are very stable.

To put it bluntly, routine physical examinations are not really more expensive, and don’t just follow the “universal list” on the Internet. Before you go, take two minutes to check whether you have been feeling uncomfortable recently, and whether your elders in the family have any high-risk genetic diseases. When you get to the physical examination center, talk to the consulting doctor, and the selected items will be truly suitable for you.