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First of all, let me clear something up. Money is not part of the decision making as I get paid the same no matter who I examine or what their insurance is- that amount is based on the government Medicare rate.
Next, to make an analogy, when I get my car inspected yearly, I can get new tires, change the oil, new battery, etc. but is it all necessary? Some things are more important than others, and we need to decide what is necessary and what is not according to evidence based medicine.
Evidence based medicine is now the prime determinant of how medicine is practiced today. If one thousanth of one percent of all persons aged 30 had a heart attack, should we stress test everyone? Of course, that tiny minority who had the heart attack would say yes, but since we do not live in a vaccuum, we know the tens of millions of dollars those stress tests cost could better be applied to malaria medications in a third world country and perhaps save thousands, maybe tens of thousands of lives. That is why a discussion such as this needs to address the resources available as a limiting factor to what is ordered.
Getting back to your question, a mid thirties male without complaints should have a good physical examination as you mentioned but without the rectal. Fasting bw for trig, chol, LDL, HDL. I usually add homocysteine and C-reactive protein levels as independant risk factors for heart disease. Discussion regarding diet, exercise, tobacco, alcohol, and safe sex, and the importance of yearly physicals.
What we do during the physical depends on age, sex, family history, prior personal history and risk taking behaviour(IV drugs for instance). This exam is for the healthiest segment and certainly is not a guide for all 30ish men.
And why does this discussion bug you Brian? It is certainly appropriate you get a physical. I think the last couple paragraphs would be a good guide as far as what would be done for you( I would ask for the homocysteine and CRP)
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For me there is only the traveling on paths that have heart, on any path that may have heart. There I travel, and the only worthwhile challenge is to traverse its full length. And there I travel, looking, looking, ...breathlessly.
-Carlos Castaneda
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