Are Annual Exams Still Necessary?
Annual Physical Exams
When I played sports in high school, I had to have an annual physical every August. My physician, complete with gnarled hands and white hair, was so old-school that he still made house calls for his most distressed patients. These physicals usually lasted less than 10 minutes, during which time, a nurse measured my height, weight, and blood pressure, and the doctor felt my spine and listened to me breathe in and out. I’d walk out feeling pretty miffed that I had to waste my time just to get a signed piece of paper that approved my athleticism.
I no longer go for annual physicals, but these exams continue to be mainstays for many people in America. They have been previously heralded as a great way to quickly diagnose potential problems and ward off long-term illness. Now, however, the medical profession has become divided on the value of these costly yearly checkups.
Some doctors argue these types of physical exams build trust between patients and doctors. Critics, on the other hand, state that they are often too expensive for patients, and the often false positives from routine testing make the visits unproductive.
In 2007, a study found the U.S. health system spent $7.8 billion in combined cost for the approximately 44.4 million U.S. adults who received a yearly physical exam, and more than $350 million per year was spent for laboratory testing, including complete blood cell counts and urinalyses.
It turns out that the debate concerning physicals has been raging for more than a century. In the 1960s and 70s, two large, randomized controlled trials were conducted, and both studies showed little positive impact – people who had physicals did not seem to live longer or have less illness than those who did not have physicals.
Confusion seems to creep in when talking about preventive health exams versus preventive care in general. Mammograms, pap smears, and PSA testing are considered preventive care procedures – and there’s clear evidence that these exams are beneficial for patients. However, the special visit for preventive care (the physical) is a different entity altogether. Doctors have previously found that 80 percent of preventive services are provided at other types of visits. In fact, the vast majority of patients who come in for a physical exam have already seen their physicians for some other reason in the previous 12 months.
A 2012 review from Danish researchers concluded that routine exams conducted on healthy people offer little benefit. The researchers analyzed information from 183,000 people who participated in 14 trials carried out in Europe and the United States. In all the trials, participants were randomly assigned to either receive a typical health check – involving screening tests, a physical exam or advice about lifestyle changes – or not receive one.
Results showed patients who received the health checks were just as likely to die over a nine-year period as those who received no physical. Routine checks also had no bearing on hospital admission rates, patient worries, referrals to specialists, or time missed from work.
Some physicians now suggest that, instead of focusing on special visits like yearly exams, health care providers should focus on the services that are more individualized. Thus, rather than providing preventive exams to every 25-year-old woman, a pap smear or cholesterol screening may be more prudent.
In the meantime, until new guidelines are established, patients should discuss their own health care needs with their physicians. Stay current with preventive health services (like colon cancer screenings and mammograms) supported by everyone in the physician community, and take heed if a doctors says, “You don’t need to come in next year.”