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Screening for asymptomatic diseases in your patients. Practical tips for doing it right.

Ms. Smith is a 64-year-old white woman who comes to the office for a "check-up." She has had a slight "weight problem" and some "high blood pressure," but has been in otherwise good health. She is 64 inches tall, weighs 186 pounds, and her blood pressure is 145/90. At the conclusion of an otherwise normal exam, the topic of health screening regarding breast cancer comes up. She declines a mammogram stating that she checks herself "pretty often" and that no other physician has ever felt lumps. Besides, she is "too old to worry about getting mammograms now," and one of her best friends told her that mammograms "really hurt bad."