Once upon a time, an annual adult physical typically included a weight and blood pressure check; blood tests to measure white blood cell counts and cholesterol, iron, and thyroid hormone levels; a urinalysis; and diet and exercise counseling. For older adults, chest x-rays and electrocardiograms (ECGs) also were routine. How things have changed …

Since the 1980s, the United States Preventive Services Task Force (USPSTF) has argued against these traditional exams. The committee's review of available evidence on the standard screening tests revealed that they rarely detected or prevented underlying diseases in healthy adults who weren't experiencing symptoms.

So instead of the traditional annual physical, which can be time consuming and expensive, the USPSTF recommends that doctors provide preventive services only as needed based on age, gender, family history, and -- most important -- symptoms. In other words, blood tests that measure white blood cell counts aren't necessary unless you're experiencing symptoms that suggest an underlying infection, and ECGs are recommended only for patients with risk factors for or symptoms of heart disease. This "as-needed" approach means that you play an important role in managing your own preventive care.

To get a better idea of how patients and their doctors are using their time together, researchers writing in the Archives of Internal Medicine analyzed the medical records from more than 8,000 doctors. The investigators found that one third of all scheduled office visits were considered "annual physicals." The majority of the patients seen at these office visits received or were referred for recommended preventive services including mammograms, prostate specific antigen (PSA) tests, pap tests, cholesterol checks, smoking cessation counseling, weight loss counseling, and exercise and/or nutrition counseling. However, 11% of patients received a series of blood tests that the USPSTF labels unnecessary for asymptomatic adults.

By being proactive, you can avoid unnecessary tests and ensure you're up to date on appropriate screenings. Also, be aware of what vaccines you need:

• Influenza: Every year
• Pneumonia: At least once starting at age 65
• Tetanus/diptheria: Every 10 years; after age 64, one booster should include pertussis (whooping cough)
• Chickenpox: Once for anyone who's never had it
• Shingles: Once after age 60

Some final advice:

• Make your doctor visits work for you by bringing a list of concerns to your appointments.
• Bring a list of the medications, vitamins, and other supplements you're taking.
• Share your lists with your doctor at the beginning of the visit so you don't have to rush through important issues at the end of a hurried doctor's appointment.