Does counseling of Mr T also require a physical examination? It is widely believed that asymptomatic people should have a complete annual examination. Although this belief was questioned as early as 1945 [14], it was not challenged until the 1970s, when Frame and Carlson [15] recommended replacing the complete annual examination with periodic examinations tailored to a patient’s age, gender, and risk indicators for disease . These periodic examinations would consist of screening for high-risk behaviors with a focus on the most frequent causes of death in persons of the same gender and age. Within a decade, their recommendations were supplemented by those of the Canadian Task Force on the Periodic Health Examination, and the US Preventive Services Task Force [16].

For example, in 2012, the leading causes of death in asymptomatic American men between 55 and 64 years of age were ischemic heart disease, lung cancer, colorectal cancer, chronic lower respiratory diseases, accidents, diabetes mellitus, cerebro-vascular disorders, chronic liver disease, and suicide [17]. The risk indicators for these disorders are family history (ischemic heart disease, colorectal cancer, diabetes, cerebro-vascular disorders, and suicide); smoking (ischemic heart disease, lung cancer, and chronic lung disease), sedentary lifestyle, obesity, and hypertension (ischemic heart disease, diabetes, and cerebro-vascular disorders), exposure to asbestos and chromium (lung cancer), history of reckless driving, alcoholism, drug abuse, depression (accidents), and history of alcoholism, unprotected sex and illicit IV drug abuse (chronic liver disease), and history of depression and lack of social support (suicide). The Canadian Task Force on the Periodic Health Examination, and the US Preventive Services Task Force specify the recommended investigation and follow-up in persons with and without risk indicators or physical findings for disease. In addition, the American Academy of Family Physicians recommends that asymptomatic men 45–65 years of age be screened for sedentary lifestile, smoking, obesity, hypertension, hyperlipidemia, alcohol misuse, visual disturbances, hearing loss, dental hygiene, and immunizations [18].