Many Americans ritualistically schedule and check in to an annual physical examination. About one-third of American adults receive a physical every year, a practice that has recently been questioned more and more. Some doctors are calling for the once-a-year physical to be abandoned because of a lack of results, but others defend the practice as beneficial. Two editorials published in the Oct. 15 New England Journal of Medicinebattle it out, airing reasons for or against annual physicals. Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School in Boston, and Dr. Allan Prochazka,argue that eliminating the annual physical would improve the value of health care, and do away with a practice that really isn’t beneficial — and may actually be harmful. The content of the annual physical exam is “poorly defined and its focus has evolved over time,” according to Mehrotra, but potential components include things like screening questions for history taking, physical aspects like urine tests and blood pressure measurements. The idea is that doctors would use this opportunity to detect problems in patients, and preemptively stop chronic illnesses from developing. This isn’t really the case, though. “In good studies, in both randomized trials and observational studies, we have not found any of those benefits,” said Mehrota to MedicineNet. “We have not seen people have less illness, and we have not seen any decrease in mortality.” Annual checkups cost over $10 billion a year, according to Mehrotra, and sometimes they even cause harm. Many tests in patients with no symptoms can yield false positives, leaving patients anxiety-ridden about a condition they don’t actually have. “I’m a big fan of trying to do anything that’s going to help the health of the U.S.,” Mehrotra said. “But in this case, we’ve studied it, and it hasn’t helped. We shouldn’t waste time and money on this.” On the flip side, Dr. Allan Goroll penned an editorial in favor of the annual physical, citing important patient-doctor relationships as a reason to keep the practice. Learning about the various aspects of a patient’s life — family and work stresses, financial pressures, habits — is important for a doctor to understand because they can affect health and well-being. “That can’t be done in five minutes, and it can’t be done by a questionnaire,” Goroll said. “It’s don’e by looking a patient in the eye and giving them the feeling they aren’t being rushed. By calling for the elimination of the annual checkup, they risk compromising the delivery of a comprehensive, whole-person approach to health care.” Both of the editorials, however, called for some reforms of the system. Mehrotra said a computer can easily keep track of things like who needs a flu shot, and who needs to get their blood pressure checked again, eliminating the need for a universal annual checkup. However, regular checkups are more logical for patients who haven’t seen their physician in a good amount of time. “I do acknowledge for people who haven’t seen a primary care doctor for several years, going in to maintain that relationship does make sense,” he said. Goroll supports the idea of an annual physical, but in a team-based approach. This means that nurses, assistants, and care coordinators would be handling most of the preventive-care processes, freeing up doctors for more in-depth conversations with patients about their health. “Let’s not eliminate the annual physical, which is really an annual health review, but let’s enhance it so it’s a meaningful experience,” he said. Source
