The Well-Woman Visit
Feeling well? Great! It’s time to go to the doctor. Confused? Here’s the deal: even if you’re feeling well and have no medical concerns, it can still be worth your while to check in annually with your primary care provider to discuss family history, prevention, and screening time lines to keep your health on track.
While research shows that annual visits do not reduce your risk of death or hospitalization,1 and some may result in unnecessary follow-up or false-positive test results, Mary Ann Bauman, MD, medical director for Women’s Health Community Relations at INTEGRIS Health in Oklahoma City, says the appointment can still provide considerable benefit.
“I’m very much in favor of an annual physical,” Dr. Bauman says. “It’s a chance for your doctor to get a thorough picture of your overall health and to take you through all the healthy lifestyle factors that can make a big difference in the prevention of heart disease, as well as cancer, diabetes, and other conditions.”
Even with these benefits, many women do not see a primary care physician every year. One reason the annual appointment doesn’t make the calendar is the misperception that a well-woman visit is focused only on gynecologic health. While women may have historically made annual appointments to schedule a Pap test, when guidelines for cervical cancer screening were updated in 2012 to recommend a Pap test every three years rather than annually,2 many assumed that that meant they didn’t need any type of regular visit with their doctor.
“Women may think, Well, I don’t need a Pap smear, so I don’t need an annual exam,” Dr. Bauman says, “but that couldn’t be further from the truth.” This is because a well-woman visit actually covers a thorough exam of all the body’s organ systems and includes a comprehensive conversation about family history, lifestyle behaviors, and emotional well-being.
Dr. Bauman says that when she sees patients for an annual exam, she starts with taking vital signs (blood pressure, pulse, and temperature), notes their weight, and asks detailed questions about how they’re feeling physically, as well as about stress and sleep patterns. As she continues to examine the body—listening to the lungs and the heart; examining the abdomen and the breasts; performing a pelvic exam if indicated, with a Pap test if appropriate; and checking legs and feet for swelling—she will engage the patient in dialogue about each area of the body to discuss any concerns or questions.
One essential thread throughout a well-woman visit is heart health. According to the American Heart Association, heart disease is the number one killer of women, and the annual exam can provide valuable information about symptom awareness and lifestyle factors that can be part of a preventive strategy. Dr. Bauman, an American Heart Association Go Red For Women spokesperson, says that specific topics she will cover related to heart health include overweight or obesity, which can increase risk of heart disease and stroke; exercise tolerance, which, when decreased, can suggest a cardiac issue; any changes to the level of fatigue; sweating accompanied by nausea or chest pain; blood pressure; and swelling in the legs or feet.
While some heart health issues and other disease and condition issues covered during an annual visit will require medication or further testing, many can be addressed with lifestyle recommendations. Dr. Bauman says that exercise is a topic she prioritizes, as are smoking and alcohol consumption. She is also sure to impart the value of healthy sleep habits and stress reduction, both of which contribute to overall well-being. “I’m a big believer in the mind-body connection,” she says. “If you’re not emotionally well, you won’t feel good physically.”
Before You Go
Taking time to gather information before your visit can result in a more productive conversation with your physician.
One of the key elements of an annual conversation with your physician is a discussion of your family health history, so gathering that information in advance of your appointment can be time well spent. Sharing information about diseases and conditions present in your family—especially heart disease, cancer, and diabetes—can provide important insight for your physician.
Dr. Bauman says that she generally takes a detailed family history upon first meeting a patient and then updates that information at each subsequent visit to note any new diagnoses or changes in the family. This information can prompt discussions about general preventive care, customized cancer screening schedules, and sometimes the value of genetic testing.
In addition to gathering family history, Dr. Bauman recommends that patients come prepared with a few additional types of information: clear descriptions of any symptoms they may be experiencing (precisely where, when, onset, and treatment to date); a specific quantity of alcohol they consume (if any); current sleep patterns; blood pressure readings, for those diagnosed with hypertension; and recent blood sugar levels, for those with diabetes. Arriving with this information in hand can save time during the exam and result in a more detailed picture of your health to guide lifestyle decisions and resolve any current issues.
1.Krogsbøll LT, Jørgensen KJ, Grønhøj LC, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345:e7191. doi: .
General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis
Objectives To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes. Design Cochrane systematic review and meta-analysis of randomised trials. For mortality, we analysed the results with random effects meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. Data sources Medline, EMBASE, Healthstar, Cochrane Library, Cochrane Central Register of Controlled Trials, CINAHL, EPOC register, ClinicalTrials.gov, and WHO ICTRP, supplemented by manual searches of reference lists of included studies, citation tracking (Web of Knowledge), and contacts with trialists. Selection criteria Randomised trials comparing health checks with no health checks in adult populations unselected for disease or risk factors. Health checks defined as screening general populations for more than one disease or risk factor in more than one organ system. We did not include geriatric trials. Data extraction Two observers independently assessed eligibility, extracted data, and assessed the risk of bias. We contacted authors for additional outcomes or trial details when necessary. Results We identified 16 trials, 14 of which had available outcome data (182 880 participants). Nine trials provided data on total mortality (11 940 deaths), and they gave a risk ratio of 0.99 (95% confidence interval 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (4567 deaths), risk ratio 1.03 (0.91 to 1.17), and eight on cancer mortality (3663 deaths), risk ratio 1.01 (0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings. We did not find beneficial effects of general health checks on morbidity, hospitalisation, disability, worry, additional physician visits, or absence from work, but not all trials reported on these outcomes. One trial found that health checks led to a 20% increase in the total number of new diagnoses per participant over six years compared with the control group and an increased number of people with self reported chronic conditions, and one trial found an increased prevalence of hypertension and hypercholesterolaemia. Two out of four trials found an increased use of antihypertensives. Two out of four trials found small beneficial effects on self reported health, which could be due to bias. Conclusions General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported. Systematic review registration Cochrane Library, doi:[10.1002/14651858.CD009009]. : http://dx.doi.org/10.1002/14651858.CD009009
2.Moyer VA, US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2012;156(12):880-91. doi: 10.7326/0003-4819-156-12-201206190-00424.