Monday, September 24, 2007

Routine Annual Physical - Not Worth the Time or Money

A recent article in the September 24th issue of Archives of Internal Medicine found that routine annual physicals may not be particularly useful. Although these types of visits account for 1 in 12 doctor office visits, the study found:
  • only 19.9 percent of eight preventive services were provided at these examinations as opposed to other types of physician visits.
  • only 8.8% of weight reduction counseling occurred during these visits.
  • obtaining mammograms, checking for cholesterol, and recommending patients quit smoking occurred at more than half of these encounters.
  • individuals in the Northeast 60 percent more likely to receive a routine physical than those in the West. (Note a recent study in Health Affairs also found that health care costs per capita were higher in the Northeast).
"We need to question encouraging everybody to come in for an annual physical," Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine and the RAND Corp., who led the study, said in a telephone interview.

"There's a lot of money, a lot of visits, a lot of adults going to see their doctor for annual physical exams with a real unclear benefit. It's the No. 1 reason adults see their doctor, and yet we don't know whether it's helpful or not," he added.

This is hardly a surprise. The value of having a routine physical is no more beneficial in finding problems than having your mechanic check your car, which runs completely fine, annually just in case. For decades, there has been no scientific evidence that an annual physical helps save lives. For those who are otherwise healthy, don't take prescription medications regularly for high blood pressure, diabetes, cholesterol, asthma, emphysema, or other potentially serious medical problems, there isn't much gained from a "check-up".

That should not, however, mean that individuals should avoid doctors either. Like you car which has a maintenance light which indicates servicing is required, patients must have tests that screen for various medical problems and cancers based on the age and gender of the patient. For example, all women without a family history of breast cancer should have a mammogram starting at age 40 and repeat every one to two years. While this screening could be done during an annual physical, the screening could be done at any other future visit. The study showed that many of these preventive interventions occurred at other office encounters.

Find out what tests you are due for at the U.S. Preventive Services Task Force. It is a good start, but not the final word. Check out other organizations like the American Cancer Society, the American Heart Association, and the American Diabetes Association as well.

If having an annual physical helps remind you that certain tests should be done to stay well then continue the practice. Otherwise, save your time and money. Figure out what tests you do need depending on your age and then get them done - no routine annual physical necessary.

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