Are Annual Physical Exams Really Necessary?

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The following is a guest post by Anne Polta, an outstanding writer and author of the blog HealthBeat.  Please check out her work.  
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.