Health

You Probably Don't Need an Annual Physical

June 10th 2015

By:
Rebecca Hiscott

In a New York Times editorial published in January, Dr. Ezekiel J. Emanuel, an oncologist at the University of Pennsylvania, wrote that he had resolved to forgo his annual physical in 2015. Not having one, he wrote, "is one small way I can help reduce healthcare costs — and save myself time, worry and a worthless exam."

Dr. Emanuel in his essay distilled the key reasons why more and more physicians have become comfortable advising that patients skip the time-honored tradition of the annual check-up, if the patients are otherwise healthy and symptom-free. It is time-consuming, it carries the risk of false positives, and it's patently unhelpful at identifying real health problems.

So, do you need to have an annual physical?

There's data to back up Dr. Emanuel's position. An often-cited 2012 study published in the British Medical Journal by the Cochrane Collaboration — an international network of researchers that reviews published medical research to provide evidence-based guidance pertaining to public health — reviewed 14 randomized, controlled clinical trials of annual "wellness visits" involving more than 182,000 people. It found that routine health screenings — those not precipitated by some sort of symptom or health concern — did nothing to reduce death or disability from disease overall, or morbidity and mortality related to heart disease or cancer.

The annual screening may even cause overt distress, some physicians argue, because of the risk of false positives, says Dr. Ateev Mehrotra, a health policy researcher and physician at the University of Pittsburgh School of Medicine. "If you take people who are otherwise healthy and you find an abnormality when you're listening to their lungs or you do their blood work, you need to repeat the test or do a follow-on test, and in the end you likely find out that it was nothing," Dr. Mehrotra told ATTN:. That's potentially causing undue stress, not to mention "a lot of time and a lot of lost productivity" on the part of the physician and patient alike.

Take this example: My first-ever gynecological exam, at age 18, turned up a lesion that the doctor assured me was probably nothing. Sure enough, nine months and three biopsies — and the flustering experience of having several medical students staring intently at my cervix — later, I was given a clean bill of cervical health. I wouldn't consider myself harmed by the experience, but it wasn't particularly pleasant, either.

Given the stark data, the time and energy expended on annual check-ups that do absolutely nothing to improve the outcomes of otherwise healthy people would seem to put undue financial, emotional, and logistical strain on the patient, the physician, and the healthcare industry as a whole.

But there’s a “but”

One of the most valuable aspects of the annual physical may simply be the act of participating in the exam — of building a relationship with a physician and a medical practice, so that when a health concern arises, you're not left totally rudderless. "It doesn't have to be every year, by any means," says Dr. Mehrotra, "but there is some value in having what I might call a 'relationship initiation visit,' so that you're in the doctor's records, you've been there before, and the next time something does happen, you know where to go."

Plus, a check-up every few years, even if you're feeling fine, could help doctors pinpoint signs of trouble ahead, says Dr. Geoffrey Rutledge, an internist and emergency medicine physician with faculty appointments at Harvard and Stanford Medical Schools. Dr. Rutledge is also the chief medical officer and co-founder of HealthTap, a digital service that allows people to connect with physicians and ask health questions remotely.

"If you have a strong family history of one condition or if you have other risk factors for bad health — whether those are genetic or related to your lifestyle, medications, or prior conditions that may predispose you to other health problems — then having an evaluation to see if you're someone who needs ongoing care or monitoring makes a huge amount of sense," he says. "But I would also suggest that the more powerful way to spend time and energy related to health is to think about what you can do to maintain and support better health in your life, like diet and exercise. If both of your parents developed diabetes in their fifties, what can you do to make that not happen?"

Clinicians may also be putting too much stock in the studies, including the Cochrane review, that seem to show unambiguous evidence against performing the annual exam. "Basically, the studies are insurance company physicals that are removed from the patient's primary care doctor — a phone call from a case manager at an insurance company and a battery of routine blood tests, or a visit at a wellness clinic," says Dr. Michael Hochman, a primary care physician and medical director at AltaMed Health Services in Southern California, and an assistant clinical professor of medicine at UCLA. "The data on that is pretty clear: There's no benefit. But what there isn't evidence on, one way or the other, is whether seeing your own primary care physician is beneficial. And that's the key question."

Seeing your own primary care physician, Dr. Hochman says, is a very different experience from an insurance physical. A doctor with whom you have a pre-existing relationship, who knows you and your health history well, may be more likely to pick up on risk factors for chronic conditions or recommend preventive screening measures, for instance.

Annual checkup vs. preventative care

And an annual check-up should not be mistaken for preventive care, which is extremely valuable, Dr. Mehrotra says. The United States Preventive Services Task Force, a national group of health care policy experts and practitioners, provides evidence-based guidance on what screening tests are shown to improve patient outcomes and when people should start thinking about them. The task force offers guidelines on when men should start getting colonoscopies and prostate exams, for example, or how often women should be getting Pap smears and cervical cancer screening. Physicians are, by and large, in agreement with these recommendations. (The task force, it should be noted, does not have a recommendation about annual physicals.)

"We certainly have a lot of waste in the health care system, and we probably do, in fairness, overdo the wellness visits," says Dr. Hochman. "But that doesn't mean there's no value in it."

And if you've got a persistent symptom that's causing you anxiety and worry, he urges, see a doctor.