The annual physical: yes or no?

It’s almost July, which means a postcard will soon be arriving in the mail, reminding me my cat is due for her yearly visit to the veterinary clinic. As usual, I’ll make an appointment and bring her in (although I suspect she’d rather we just skip the whole deal).

Do annual visits to the doctor make sense? Are people healthier when they receive yearly checkups, or is the yearly visit something we do mostly because we think we’re supposed to?

There’s a fair amount of debate in the medical world about the value of that time-honored custom, the annual checkup. Many experts question whether it’s really necessary to subject healthy, asymptomatic adults to a battery of one-size-fits-all tests that might or might not be helpful.

As long ago as 1989, the U.S. Preventive Services Task Force, an independent panel of experts that weighs the evidence and issues recommendations on the use of screening and preventive health care services, found insufficient proof to endorse the benefits of the standard yearly checkup for otherwise healthy adults.

The task force has not suggested that people can skip seeing a doctor unless they’re sick. Rather, guidelines by the USPSTF, researchers and other physician groups increasingly have tilted in favor of individualized assessment and counseling based on the patient’s age, gender, risk factors, health history and preferences. In other words, EKGs don’t need to be administered to every middle-aged person who comes in for a physical, nor does everyone need to have annual chest X-rays or a comprehensive blood panel unless there’s a reason for doing so.

This isn’t always an easy message to convey, especially to an American public who’s accustomed to being told to get screened for everything.

The whole issue, in fact, is more nuanced than it appears. When a group of researchers undertook a review a few years ago of the evidence on the pros vs. cons of the routine physical, the results were mixed. In their findings, published in 2007 in the Annals of Internal Medicine, the researchers reported consistently clear benefits for regular cholesterol screening, gynecological exams, Pap smears and fecal occult blood testing. Regular physical exams also appeared to be reassuring for patients. But the benefits were less clear on other measures, such as whether regular checkups resulted in better clinical outcomes, fewer hospitalizations or lower health care costs.

Why, then, do we continue to have regular checkups, and why do most doctors continue to believe they’re an important part of health care? The real benefit, it seems, lies in the intangible things: the opportunity for doctor and patient to get to know each other and to develop a relationship when the patient is well rather than sick or in the middle of a crisis.

Dr. Steven Reznick, who has a concierge practice in Boca Raton, Fla., tackled this very issue last week in a guest essay at Kevin, MD. “Is it cost-effective? Does it prevent disease? It doesn’t matter,” he wrote. “It is an essential part of the development and continuation of the doctor-patient relationship.”

It’s also a way to benchmark the patient’s health from one year to the next and address important issues such as previous illnesses, family history and lifestyle, Dr. Reznick writes.

In a column that appeared a couple of years ago in the Wall Street Journal, Dr. Benjamin Brewer takes the debate one step farther:

The annual physical gets a thumbs-down from public-health researchers who find no real evidence to support its effectiveness, despite tradition and widespread use.

Physicians continue to perform the exams, patients continue to request them, and many insurers pay for them. The question is why? Should we keep spending money on a health-care intervention without a proven benefit?

My answer is yes. I believe there is more to the annual exam than researchers have studied so far. If they haven’t found a direct benefit, then I’d say they’re not asking the right questions.

Health is more than the absence of disease, and quality care is more than the sum of the tests that can be done on your organ systems. Relationship-based care has a beneficial impact on health quality, costs and outcomes that goes way beyond disease detection and health screening.

There’s nothing wrong with debating the value of the annual physical exam. Indeed, it’s a question that needs to be asked. But like many things about health care, the answer isn’t always straightforward or easy to quantify. Even though we might not be able to objectively measure the benefit of the yearly exam, it seems it’s still a worthwhile thing to do.

2 thoughts on “The annual physical: yes or no?

  1. Pingback: Do we really need annual check-ups? | Reporting on Health

  2. I see my wonderful internist generally once a year, for this very reason. Circumstances earlier in life prevent me from forgoing pap tests (kudos to whoever came up with thin prep!), and a biopsy this year has done the same for mammograms (kudos to the inventor of the stereotactic biopsy technique, and especially to my team). A couple of chronic conditions that need monitoring are taken care of then as well. (There are the rare exceptions.)

    I would much rather go to my internist once a year for an all-clear than end up in the ER or hospital for something that could easily have been prevented by a brief chat during an annual exam.

    Internal medicine and primary care physicians are a dwindling resource, being lost due to the off-balance payment scheme that favors physicians that do procedures over physicians who provide cognitive services.

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