Ocean and the Non-Annual, Non-Physical Exam

The traditional “annual physical” is controversial these days. Recent studies have shown that people that come in for their physical don’t seem to be any healthier than those who do not. Many experts believe this is due to the excessive time spent on traditional, non-evidence-based aspects of a physical exam. For example, listening to the chest of a perfectly healthy patient with no respiratory problems does not help much at all; we only do it because that’s what we’ve traditionally done.

Consequently, primary care industry experts have placed increasing emphasis on a more flexible visit, the “periodic health exam”.

The periodic health exam is similar to the annual physical, but it focuses less on the physical exam and more on concrete things that we can do as family doctors to prevent illness. Fundamentally, it’s a checklist consisting of evidence-based interventions: colon cancer screening, blood work, immunizations, pap tests, smoking cessation, and so on. The visit provides an opportunity for the doctor to ensure these items are kept up-to-date.

Can you cover basic periodic health exam questions & still handle a patient's biggest concerns in a 15 min appt? Click To Tweet

Patients however still tend to view their “physical” as not just a full checkup, but also an opportunity to discuss anything and everything that matters to them with their doctor. All of these issues unfortunately require a lot of interviewing time to glean the necessary information to make an informed medical decision. Rarely is there enough time to cover both the doctor’s care checklist and the patient’s concerns.

As a family doctor, given the limited 15-20 minute time frame we have for a typical visit, the question remains – how do we attempt to cover all of the basic periodic health exam questions, yet still leave time to handle the issues of highest concern to the patient?

Sample-Periodic-Visit-Results

Click the image to view a sample patient chart with a note summarizing the patient’s Ocean questionnaire responses.

This is where patient questionnaires can make a huge difference. In my practice, I like to use Ocean to give the patient a way to review and answer questions about key issues before they arrive. This way, I can effectively build an agenda in advance of the visit.

To do this, I queue up a suite of questionnaires tailored to the individual patient needs. Starting with the Periodic Health Exam Ocean questionnaire, I cover all the usual questions: smoking status, alcohol, exercise, and so on. Next, I check my list of reminders in the EMR: are they due for a pap? If so, tack on the Pap Reminder questionnaire. Is a tetanus shot due? Add the Tetanus Invitation questionnaire as well. Bone Mineral Density testing? You get the idea.

If I have the patient’s email address and consent, I’ll send the forms online before the visit. If the patient doesn’t complete the questionnaire from home in advance, they can answer them on a tablet in the waiting room. In either case, Ocean has my agenda covered and documented in the EMR before I even walk in the room. I can easily review the summary note in the patient chart (see the image above) before seeing the patient. That leaves ample time to have a natural conversation with the patient and focus on their most important concerns.

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