Nowadays, most patients head for their doctors' clinics for check-ups more than for any other reasons. The ostensible objective is to ward off disease. In fact, of late, the annual medical check-up has become a ritual in many companies for many executives. While most patients assume that this is a standardized routine, a debate still rages in the medical profession regarding what tests ought to be performed, on whom, beginning when and how often.
Often, patients seem to fall into two extreme categories those who get no routine medical care and those who receive excessive medical care, including screening tests, even though they do not really 'need' them. Periodic tests
ill'll and examinations should not become 'routine' or part of a standard 'one-size-fits-all' pack age. In order to be really effective, they need to be tailored according to a person's age, sex, family history and personal risk factors. Unfortunately, due to the widespread fallacy that.the human body is no better than a machine, we have been taught that the body needs 'routine maintenance' which should be performed by a doctor, much as your mechanic tunes up your car periodically. However, medical experts have debunked such an analogy as being a gross oversimplification. They have emphatically stated that screenings and early detection are not a universal panacea to ward off all ills.

Who needs medical attention!

While it is true that the concept of routine testing 011 a regular basis sounds attractive (after all, isn't prevention much better than cure?), remember that your body is not a car! 'J'he major drawback of the tests conducted at present is that they are not very accurate. In other words, a large number of 'false positives' crop up; Le., patients whose test results are abnormal but have no illness in reality! Not only does an abnorm.al test result create a lot of anxiety and stress but it also leads to a merry-go-round of further tests and consultations in order to determine whether or not the original rsult has any significance.
In fact, the only routine tests that the US Preventive Services Task Force recommends are those for blood pressure, cholesterol, colorectal cancer, breast cancer and cervical cancer. This task force refused  to recommend widespread screening against other diseases for two reasons either the tests had been
found to have no merit, or there was not enough evidence to prove their benefit (Le., they did not help to improve either life expectancy or the quality of life). In fact, screening
tests could have a major negative impact on one's health, which is why they should be undertaken with a great deal of discretion and caution!

The US Preventive Services Task Force soq.ndly criticized physicians for frittring
away their valuable time on screening of questionable value instead of counselling people about the harmful effects of smoking, lack of exercise and other risks arising due to a faulty lifestyle. The only tests the task force recommended were
1.Periodic check-ups for blood pressure for all adults. (High blood pressure is a leading risk factor for coronary heart disease, stroke, renal disease and heart attack).
2. Total blood cholesterol measurement, for men between the ages of 3!i and 65 and for women between 45 and 65 (' high cholesterol constitutes a risk factor fmheart disease). The frequency of testing was; how ever, not speciffed
3. Screening for colorectal cancer for individuals over 50, by testing the stools for the presence of blood, , or through sigmoidoscopy. Colorectil1 cancer is com
mon in the USA.
4. Mammogram (an X-ray to detect the early signs of breast cancer) for women between 50 and 69, everyone or two years.
5. The PAP smear test, to screen for cervical cancer, for sexually active women once every three years.
6. Vision tests for children before entering        school, and for the ,elderly.
7. Tests for elderly people (or those with spe     cific complains) to assess hearing loss.
Another simple but helpful test comprises measuring intraocular pressure to screen for glaucoma (which may cuse blindness). The roles of (1) routine blood sugar testing (to screen for diabetes), (2) thyroid hormones in the biood (to screen for thyroid disease) and (3) bone densitometry in menopausal women (to screen for osteoporosis) are still unclear.

It is worth remembering that even the experts differ in their recommendations! For ex ample, presently, a major controversy is raging ... as to whether mammograms should begin at the age of 40 or, 50. The rate of false positive ., results has been higher among younger women, possibly because the women in the 40 11'81 to 50 age group have denser breasts than thoseover 50. Recent studies .show that young women stand a 50 per cent chance of obtaining a false positive result over 10 years of annual mammograms. Such women endure intense anxiety and sometimes disfiguring biopsies before learning that they don't have cancer after all! Another controversy relates to the need to screen a prospective candidate for prostate cancer, either by rectal examination, or through a blood test for determining the presence of PSA (prostate-specific antigen). The PSA test measures the level of a specific protein in the blood that can indicate prostate cancer. The drawback with this test, as with most screening tests, is that an elevated level of PSA is not diagnostic of prostate cancer. In fact, a number of patients who are normal will be found to have elevated PSA levels. Then, in order to prove that they are not suffering from prostate cancer, they will. be subjected to a prostate biopsy, and sometimes even surgery, to remove the prostate altogether. The adverse consequences of widespread screening include (1) a large number of false positive results, causing needless anxiety and concern;
(2) unnecessary biopsies; and
(3) harmful effects of aggressive treatments for slow growing cancers that may never have caused symptoms in a patients's lifetime and could have been left well alone. As for testing for the early detection of other hidden cancers and early heart disease, the task force believes that physicians' time could be put to more productive use by discussing unhealthy behaviour patterns with patients. After all, a doctor can do far more good for his patient by getting him to stop smoking than by subjecting him to a battery of tests or pre
,scribing a motley bunch of pills for him! Therefore, the vital question is what can you do to get maximal benefit from a medical check-up? Remember that you do not need to go in for a check-up every year; individuals in their 20s and 30s who have no symptoms, can safely undergo a physical once every two to five years. When you go for your periodic check-up, take all relevant medical records for instance, vour medical and familv historv and

all the medications you are taking (or have takn). Also, spell out clearly (to the doctor) the details about your lifestyle. Your doctor should talk to you and listen to you during your check-up, since disease prevention is as important as detection. People without any symptoms do not need a chest X-ray, electrocardiogram or complete blood counts since these do not provide the doctor with any clinically useful information. Therefore, you do not have to subject yourself to the' delights' of such tests just because they are offered as part of the package! Many patients naively believe that the more the tests, the better the outcome. They are invariably enticed by expensive packages which offer more tests and, consequently, 'better value for money'. However, such a belief is not true! A cost-effective checkup can be very simple, and should include the following; a physical examination; measuring height, weight, pulse and blood pressure; blood tests for cholesterol; and sreening for colorectal cancer. For women apart from the preceding tests, the physical should include a PAP smear test and s.creening for detecting breast cancer.
Modem medicine has finally realized that simple common sense measures are much more effective than complex and exorbitant tests and scans for maintaining an individual's health. The trouble is that these measures are greatly undervalued by patients due to their simplicity! Therefore, it would be rather futile to squander money on unnecessary tests during your check-ups. Remember that common sense is as important as a computerized report in preventive medicine!