chapter 17 The general check-up
MOTIVATORS
HOW OFTEN?
How often a person should have a medical check-up depends on their age and general health status.
• Babies—should be opportunistically examined at the first encounter with a GP. This is often at the time of the first immunisation at 2 months, then again at 4 months, 6 months, 12 months and 18 months.
HISTORY
ELEMENTS OF THE HISTORY
Elements of the history are as follows:
• obstetric (female)—date of last normal menstrual period; frequency and duration of periods; obstetric history: number of pregnancies, deliveries (vaginal and caesarean), premature births, neonatal deaths, ectopic pregnancies, miscarriages, terminations, infertility, continence
• occupation(s)—present and past, including any occupational exposures to toxins, chemicals or pollutants
• family medical history—including age and cause of death of first- and second-degree relatives. Ask particularly about heart disease, asthma, diabetes, cancers and depression
• medication—prescription, OTC remedies and supplements and self-medication including dosage, frequency and route of administration. Women often need to be prompted about the oral contraceptive pill, many not viewing it as ‘medication’
• emotional health—moods; sleep pattern; relationships; attitude to work; signs of depression; level of satisfaction with job; family; friends; anxiety; use of alcohol, caffeine, tobacco or other drugs to alter mood
• sleep pattern—sleep latency, time of retiring to bed and waking, and total hours of sleep. Is it interrupted? Snoring or breathing pattern while sleeping, daytime sleeping and tiredness
• diet, nutrition—appetite, digestion, breakfast, snacks, lunch, dinner, fluid intake. For accuracy, this may require a food diary to be kept for several days to a week to indicate types and amounts of foods eaten
• for babies—feeding patterns and difficulties. Is the child breastfed? What formula if they are bottle-fed? Solids?
• smoking—past or current tobacco use. Did they ever smoke? How much and for how long? When did they quit? If still smoking, are they considering quitting?
• alcohol—frequency, type, amount (recorded as standard drinks per day and number of days per week or month)
• sexual history—current partner(s), new partner(s), previous sexual partner(s), previous testing for sexually transmissible infections, unprotected intercourse, sexual functioning, contraception
