Not too long ago, people only sought out medical help when they were sick or dying. “If it’s not broke, don’t fix it” was their prevailing medical strategy. But more recently, the annual exam or physical has become commonplace for people who are hoping to head off problems before it’s too late.
In fact, a resounding 92 percent of Americans feel it’s crucial to see their family physician annually for a head-to-toe check up, and 45 million Americans do just that every year.
But are annual physicals really necessary? Is it just a money-maker for doctors? And, can these exams cause more harm than help?
These are just a few of the questions physicians and healthcare systems around the nation are examining. News organizations throughout the country have also joined the discussion, which has created some confusion for consumers.
Scott Hollingshaus, MD, an internist at Riverton Hospital, says Intermountain Healthcare recommends an annual exam for all patients because they help patients live healthier lifestyles, conduct diagnostic screenings, and prevent behavioral-related ailments.
Regular check-ups are also recommended by major medical societies, such as the American College of Physicians and the American Congress of Obstetrics and Gynecologists.
“I recommend annual exams and find them to be valuable for both patients and physicians,” says Dr. Hollingshaus. “In my young healthy patients, with good lifestyles, I don’t stress they need one every year, but at least every few years.
“Apart from cancer and other screenings, such as diabetes and heart disease, the exam is beneficial to answer patient questions about health and lifestyle and to help steer them in the right direction. It’s also helpful to document any normal variants on the physical exam to refer to in future visits. Addressing misconceptions about health and discussing lifestyle behaviors that may lead to disease in the future is very helpful. There’s considerable data showing that simple interventions such as these can result in behavior changes when the interventions are given regularly.”
In fact, Intermountain has several Health and Wellness Centers – Park City, Salt Lake and St. George – that offer an executive health screening, in which patients receive an overall benchmark of their current health and fitness in a timely manner as well as a "roadmap" for maintaining their health in the future.
Here are some perspectives that have been covered in the news media:
New York Times
Ask Well: Do I Need an Annual Physical?
By Karen Weintraub
“If you didn’t go in for a complete physical, you’re only going to the doctor when you’re sick, and that makes absolutely no sense,” said Pieter Cohen, MD, an internist with the Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.
“A physical is a good time for patients to check in about medications and whether their benefits still outweigh possible side-effects, Dr. Cohen said. Physicals also provide doctor and patient a chance to get to know each other without the stress of a crisis, said David Himmelstein, MD, a professor of public health at City University of New York.
“’I think I take better care of people if I know who they are and have some sense of connection to them,’ said Dr. Himmelstein, who sees his internist every year or so.”
Your annual physical is a costly ritual, not smart medicine
By Jenny Gold
“Annual exams are free for most insurance companies as most preventive exams are under the Affordable Care Act. With patients who insist on coming in every year, many physicians are skipping the physical aspects of the test and focus on talking to them about their dietary and exercise habits, possible risks, age-appropriate vaccinations and any screening tests they may need.”
"’I think having a look at somebody is worth its weight in gold,’ says Mark Caruso, MD. “It's an important part of developing a relationship with a patient, he says, and there have been countless times when he's found real problems during an exam just like the one he gave to his patient Emanuel Vega.
"’What if Mr. Vega had had a lump or bump that wasn't right?’ Caruso asks. ’What if when he had his shirt off, Mr. Vega said, “Oh yeah, I forgot to mention this spot on my chest,' and it ended up being a melanoma we discovered early?”’”
New York Times
Skip Your Annual Exam
By Ezekiel J. Emanuel
“From a health perspective, the annual physical exam is basically worthless. Studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.
“Part of the reason is psychological; the exam provides an opportunity to talk and reaffirm the physician-patient relationship even if there is no specific complaint. There is also habit. It’s hard to change something that’s been recommended by physicians and medical organizations for more than 100 years. And then there is skepticism about the research. Almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story.
“These are proven to reduce morbidity and mortality. Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial. If they cannot, join me and make a new resolution: My medical routine won’t include an annual exam. That will free up countless hours of doctors’ time for patients who really do have a medical problem.”
So, there you have it. Some say annual exams are not needed, while others say they’re worth their weight in gold. Some insist they enhance the doctor-patient relationship while others say they do them just in case. You’ll need to decide what’s best for you.