Is Your Yearly Physical a Waste of Time?

This article originally appeared on Health Beat.

According to the American College of Physicians (ACP), instead of having an annual physical, “healthy adults should undergo a much-streamlined exam that’s focused on prevention every one to five years depending on a person’s age, sex and medical profile.”

So what does that mean, exactly? According to the U.S. Preventive Services Task Force, doctors should focus on “interventions that help patients change health-impairing habits or that spotlight emerging illnesses for which reliable and effective treatments exist.”  These include “Pap smears, mammograms, cholesterol tests, blood-pressure checks, and counseling to stop smoking, lose weight, get more exercise and eat a healthier diet.” In other words, rather than just checking for everything, doctors should focus on interventions that can be substantively linked to treatments we know work. Currently, most check-ups are comprehensive run-throughs that seem to be administered  just for their own sake, regardless of how, or even if, they relate to meaningful treatments.

For many of us, the annual physical is a fixture of our health care experience, something we assume to be both necessary and desirable. Indeed, a study released last month found that 64 million Americans a year get a physical or gynecological exam, costing a total of $7.8 billion.  Regular gynecological exams are important -- they include Pap smears that have made cervical cancer a rare disease. But the point of the general physical is less clear.  More people get annual check ups than visit doctors for respiratory conditions or high blood pressure, and the price tag for yearly physicals closes in on the $8.1 billion spent on breast cancer care.

The annual physical is second nature for both patients and doctors. But in practice it doesn’t seem to pack all that much bang for the buck. The Boston Globe reports that a September study from the Archives of Internal Medicine (AIM) found that “doctors routinely subject…patients to tests that are the equivalent of looking for a needle in a haystack, even when there's no reason to think a needle exists - complete blood counts and urine samples, for instance.” Worse still, “three-fourths of the patients who underwent physicals from 2002 through 2004 visited the doctor for other reasons in the year before their annual exam, suggesting that counseling and tests performed at the physical could have been provided earlier.”

The Buffalo News (see first link), quotes Dr. Ned Calonge, chairman of the U.S. Preventive Services Task Force -- which does not endorse yearly physicals -- as saying that “there is very little evidence, if any, that doing [comprehensive] exams yearly on patients without symptoms is good for anything.”

You might be surprised to learn that this lack of support for annual physicals has become commonplace in many parts of the medical community. Dr. Ateev Mehrotra, lead author of the September AIM study and assistant professor at the University of Pittsburgh, School of Medicine noted earlier this year that "annual exams are not recommended by any major North American clinical organization.” Despite this fact, says Mehrotra, “our health system is clearly devoting a great deal of time, money and resources” to annual check-ups -- without really knowing why. "Physicians need to reach greater consensus on what we should advise patients to do," he said. The potential disparities between physicals are thus vast -- as U.S. News and World Report put it, “one physician may order a slew of tests, even for outwardly healthy patients, while another may do little more than tap on a knee and call it a day.” So not only is the annual physical wasteful -- it’s also inconsistent.

But everything’s not necessarily lost. Concerns around annual physicals revolve around two components of the traditional checkup, the comprehensive physical exam and the gauntlet of blood, urine, thyroid, and heart tests. That means that no one seems to be criticizing the need for an updated patient history, the third pillar of the conventional check-up, suggesting that perhaps there is a point to the annual check-up.

Another potential benefit of the regular check-up is familiarity and connection -- there’s something to be said for checking in with the same doctor every year, if only to maintain open channels of communication and an ongoing sense of partnership. Dr. Jacques Carter, a primary care physician affiliated with Beth Israel Deaconess Medical Center, told the Boston Globe that regular face-to-face contact with patients is important so that doctors can “know about their history, about their kids' names, that the dog was sick last year -- all that Marcus Welby kind of stuff. It's very important to patients, and they also feel they can talk to you about a lot of things.”

It’s not at all clear, however, that these potential benefits outstrip the costs that come with seeing a healthy person who has no symptoms every year and subjecting him or her to a battery of tests that will not translate into effective care.


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