Do I have to do all the recommended tests?

No, you do not have to do all the recommended tests. The diagnostic plan is personalized. We only recommend tests that produce actionable data for your specific health profile and goals.

Is the initial diagnostic evaluation an annual physical?

The initial diagnostic evaluation includes everything in a standard annual physical and significantly more. We do not call it an annual physical because it is not a once-a-year checkbox event; it is the start of a continuous, data-driven management process.

Is the diagnostic evaluation done every year?

No, the deep diagnostic evaluation is done in your first 90 days. Subsequent years focus on monitoring, refinement, and maintaining the strategies built during onboarding.

Can I do the diagnostic evaluation if I live outside of Philadelphia?

Yes, you can do the diagnostic evaluation if you live outside Philadelphia because we are virtual-first. We coordinate lab draws and imaging local to where you are and conduct most consults via the Ultralight app.

Does insurance cover the initial diagnostic evaluation?

Insurance does not cover the membership component of the evaluation. Many of the labs ordered can be billed through your insurance or paid at our negotiated cash-pay rates. We discuss costs upfront before any non-standard testing.

What labs are included in the initial evaluation?

Labs included in the initial evaluation usually cover comprehensive metabolic and lipid panels, ApoB, Lp(a), fasting insulin, hs-CRP, full thyroid panel, sex hormones when relevant, vitamin D, B12, iron studies, and additional tests based on your history.

How soon after onboarding will I see results?

You will start seeing results during the strategy session at the end of the 90 days, with measurable changes typically showing up over the next 3 to 6 months as we refine sleep, physical activity, nutrition, and any prescribed therapies.

How does the initial evaluation handle complex chronic conditions?

For complex chronic conditions, the initial evaluation adds targeted specialty labs, imaging, and curbsides with relevant specialists. The goal is to map root drivers and integrate ongoing specialist care into a single plan.

How do you decide whether to add advanced imaging like Cleerly or full-body MRI?

We add advanced imaging like Cleerly or full-body MRI based on age, family history, lipid biology, and risk markers. For example, very high ApoB or strong family history of early heart disease often justifies a coronary CTA, while a strong family history of certain cancers may justify imaging like Grail or full-body MRI.

How does the evaluation incorporate wearable data?

The evaluation incorporates wearable data by reviewing 30 to 90 days of your Oura, Whoop, or Apple Watch trends. We focus on Deep Sleep, REM, HRV, resting heart rate, and steps as inputs into the strategy.

What is the difference between this evaluation and an executive physical at a hospital?

The difference between this evaluation and a hospital executive physical is depth, continuity, and integration. Hospital executive physicals often produce a binder of results and a one-time consult. Fishtown Medicine builds an ongoing relationship that translates findings into action over years.

How do you handle unexpected findings during the evaluation?

For unexpected findings, we prioritize same-week communication, additional confirmatory testing if needed, and immediate referral to the right specialist. You always have direct messaging access during this process.

How does the diagnostic evaluation address mental health and stress?

The diagnostic evaluation addresses mental health and stress through structured screening, hormone evaluation, sleep analysis, and HRV trends. We also coordinate with therapists or psychiatrists when needed.

How does the strategy session translate data into a plan?

The strategy session translates data into a plan by ranking your top 3 to 5 highest-leverage interventions, mapping them to GER·O·SPAN, and setting measurable targets for the next 6 to 12 months.

How is the evaluation different for women versus men?

The evaluation is different for women versus men in the depth of hormone evaluation, bone density screening, breast and pelvic imaging cadence, and considerations for perimenopause or pregnancy planning. Men typically get focused androgen, prostate, and cardiovascular emphasis based on age and history.

How does the evaluation account for family history?

The evaluation accounts for family history by adjusting screening intensity, recommended imaging, and lab cadence. Strong family history of early heart disease, certain cancers, or dementia changes the timeline and tools we use.

How do you re-evaluate progress after the first 90 days?

We re-evaluate progress after the first 90 days through follow-up labs, refined goals, and updates to your plan every 3 to 6 months. The strategy is treated as a living document, not a static report.

How does the evaluation reduce overall healthcare costs over time?

The evaluation reduces overall healthcare costs over time by catching problems early, reducing reactive specialist visits, avoiding duplicate testing, and preventing the major events (heart attack, stroke, cancer progression) that drive most lifetime healthcare spending.

The Roadmap: Your Initial Diagnostic Evaluation

TL;DR30-second take

The Fishtown Medicine initial diagnostic evaluation is a 90-day onboarding process. It includes a 60 to 90 minute deep-dive consult, advanced labs (ApoB, fasting insulin, hs-CRP, full thyroid), body composition, optional genetics and imaging, and a strategy session that produces your long-term roadmap.

The first 90 days at Fishtown Medicine are designed to build a complete, high-resolution picture of your health. The initial diagnostic evaluation moves far beyond the standard physical, using advanced data to create a roadmap for your long-term longevity.

Phase 1: The Deep-Dive Consultation

Most doctor visits in Philadelphia last 15 minutes. At Fishtown Medicine, your initial diagnostic evaluation begins with a 60 to 90 minute consultation. This is not just a clinical interview; it is a collaborative session where we explore your history, your goals, and your lifestyle context.

We use this time to:

Review your Medical History in detail.
Identify blind spots in your current health approach.
Establish your primary healthspan goals (performance, longevity, or managing complex chronic issues).
Perform a baseline Systems-Thinking Audit.

Phase 2: High-Resolution Data Collection

Once we have your "human" story, we layer in the data. We use a curated list of advanced diagnostics that provide insight the traditional system often skips.

Advanced Blood Work: We do not just look at "Normal" labs. We analyze ApoB, Lp(a), fasting insulin, full thyroid, and high-sensitivity inflammatory markers.
Genetic Blueprint: When relevant, we perform Genetic Testing to identify underlying predispositions.
Body Composition: We move beyond the scale to measure lean mass, visceral fat, and hydration.
Diagnostic Imaging: We coordinate advanced screenings like Cleerly coronary scans or full-body MRIs when indicated.

Phase 3: The Strategy Session

The finish line of the initial diagnostic evaluation is your detailed strategy session. We sit down (virtually or in person) and review every data point, then connect them into a single coherent plan.

This is not a to-do list; it is a Personalized Health Strategy. We prioritize 3 to 5 high-impact changes across the GER·O·SPAN that will move the needle on your healthspan over the next 12 months.

Guidelines from the Clinic

"I view the first 90 days as an 'investment phase.' We are building the clinical foundation that will serve you for the next 20 years. By being thorough now, we avoid the guesswork that leads to medical frustration later. I want you to walk away from this process with the clearest understanding of your health you've ever had."

How Fishtown Medicine approaches onboarding

We aim to make onboarding easy. From the moment you Book Your Call, our team handles the logistics, the record requests, and the lab coordination so you can focus on the results.

Actionable Steps for New Patients

Prepare for your diagnostic journey.

Clear the Calendar: Set aside 90 minutes for your first consult where you will not be interrupted.
Gather Your Labs: Follow our guide on Sharing Medical Records to get your history to us early.
Define Your Why: Think about the one health goal that matters most right now. Whether it is playing with your grandkids in 20 years or running a faster 5K next month, that goal anchors the entire strategy.

Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia. He takes a systems-thinking approach to help patients extend their healthspan, not just treat symptoms.

Fishtown Medicine | About

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

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Scientific References

Sniderman AD, et al. "Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review." JAMA Cardiology. 2019.
Knuuti J, et al. "2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes." European Heart Journal. 2020.
Berry SE, et al. "Human postprandial responses to food and potential for precision nutrition." Nature Medicine. 2020.
Attia P. "Outlive: The Science and Art of Longevity." Harmony Books. 2023.

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