Men who hate doctors
Feb 12, 2019
MEN WHO HATE DOCTORS: the well adult male exam
Men seem to hate coming in to see a physician so when they do visit you, take advantage of the time and do a complete exam. The history should include smoking and alcohol consumption, risk of HIV and other sexually transmitted infections. Don’t forget to ask about diet, how much they exercise.
Do a complete physical exam, but you can skip the digital rectal exam as there is no evidence that it improves mortality in prostate cancer.
Screen BP, weight, height and a calculation of BMI. Also screen for lipids if you patient is between 40-75, as the evidence for screening earlier is insufficient. However if they have a strong family history consider screening younger patients. Screen once for abdominal aortic aneurysm with ultrasound, if the patient has ever smoked, and is 65-75 years old.
Screen for prostate cancer using PSA in men 55-69, but individualize this by sharing current data with the patient, and start these discussions at age 50. If you do decide to screen, do it every 2-4 years. Defer screening until potential causes of transient PSA elevations, such as prostatitis acute urinary retention or biopsy.
Screen for colorectal cancer at 45 years of age for average-risk men and continue until at least 75 years of age. This change in guidelines from age 50 is due to increasing incidence of colorectal cancer in younger patients. Options include fecal immunochemical testing, colonoscopy, or computed tomography colonography.
Screen for lung cancer using low-dose CT in men 55 to 80 years who have at least a 30-pack-year smoking history and currently smoke or quit within the past 15 years.
Check on his past immunizations, and consider vaccinating for shingles with the new Shingrex vaccine if he is over 50. For current immunization recommendations check out this CDC page.