They Only Played Doctors On TV, So Should You Take Their Advice And Get Yearly Checkups?

No question, that new Cigna CI +0.29% commercial with a bunch of everyone’s favorite TV docs is entertaining.

I mean, it’s great to see Dr. McDreamy (Grey’s Anatomy) back from the dead and Hawkeye Pierce (MASH) back from the Korean War.

But I’m not sure their advice holds saline.

“We’re partnering with Cigna to help save lives,” says Noah Wylie, who is not a doctor but played one on ER.

“By getting you to a real doctor for an annual checkup,” adds Lisa Edelstein, who is not a doctor but played one on House.

The thing is, there’s some debate among real doctors, not people who played them on TV, about whether annual checkups actually do save lives. Intuitively, it makes sense that seeing a doctor every year, even if you’re not sick, would help keep you healthy. Unfortunately, there’s a lack of scientific evidence to either support or refute that notion. On the one hand, an annual checkup might uncover a health problem you didn’t realize you had, but on the other hand, it could lead to unnecessary and potentially harmful tests and procedures.

“While I found the commercial amusing, I disagree with the fundamental message,” Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School, told me. “It is not clear that having more Americans go in for annual physicals saves lives.”

I sought Mehrotra’s opinion about the commercial because of an opinion piece he coauthored a year ago in the New England Journal of Medicine. In it, he and Dr. Alan Prochazka, a general internist at the University of Colorado Health Sciences Center in Denver, argue against the annual physical, a.k.a. “annual preventive exam,” a.k.a. “periodic health exam.”

About a third of U.S. adults get an annual physical, Mehrotra and Prochazka wrote. “It is the single most common reason that U.S. patients seek care, and, cumulatively, these visits cost more than $10 billion per year,” they wrote.

Drawing any conclusions about whether annual checkups for healthy people are worth the time and effort is tricky, though, Mehrotra and Prochazka said. That’s because the studies looking into that question compare not only apples and oranges but a wide assortment of fruits and veggies. Just as patients call annual checkups by different names, so do doctors have different ideas of what their content should be.

“Eliminating the annual physical might appear contradictory to our healthcare system’s increased attention to prevention,” Mehrotra and Prochazka wrote. “But it is evidence-based prevention that’s key, and the annual physical is not evidence-based.”

Cochrane, an independent, international organization that reviews the scientific evidence about the effects of healthcare, concluded in 2012 that although “health checks” resulted in more diagnoses, they did not keep people healthier or save lives. One reason might be that most of the trials they reviewed were old–several began in the 1960s–and used different treatments than physicians would today, such as niacin instead of statins for high cholesterol, the authors wrote. “However, it is not a given that the results would be better today, as medical innovations sometimes prove harmful,” they said.


Mehrotra also coauthored a piece in February in the Annals of Internal Medicine that asked the question: Should patients have periodic health examinations (PHE)? “Considerable research has not demonstrated a substantial benefit of the PHE,” he and his coauthors wrote. For that reason, they noted, the American Board of Internal Medicine (ABIM) Foundation and the Society of General Internal Medicine (SGIM) have concluded that doctors and patients should question the need for routine checkups in healthy people.

The SGIM is pretty blunt. “Annual physicals usually don’t make you healthier,” the organization states in boldface on the website for “Choosing Wisely,” a campaign launched in 2012 by the ABIM Foundation. “Tests and screenings can cause problems.” The SGIM, which defines annual physicals as “office visits between a health professional and a patient exclusively for preventive counseling and screening tests,” is in the process of reviewing its 2013 “Choosing Wisely” stand on the subject. Whether the organization is going to change its opinion isn’t yet known.

I asked Cigna spokesman Joe Mondy about the point of the TV docs’ commercial. Was Cigna really trying to encourage all of its 15 million global medical customers to get annual checkups?

“An annual checkup is not a panacea for good health, but it can be a lifesaver for connecting individuals with their doctors,” Mondy told me in an email. “Roughly half of Americans either do not have or do not see a doctor on an annual basis. Our campaign is designed to create a bridge between people and their physician, or, if they don’t have a family doctor, [encourage them] to get one.”

At the annual checkup, Mondy said, doctors can check four important health risk factors: body mass index, or BMI, blood pressure, cholesterol and blood sugar. “The fact is that most chronic conditions are avoidable or treatable if addressed early,” he said.

Perhaps Cigna should have edited out one little word from the commercial:annual.

“Without solid evidence, affluent, well-educated patients with unfettered access to care might reasonably choose longer intervals between routine visits,” Dr. David Himmelstein, a public health professor at the City University of New York and Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School, acknowledged in January in an opinion piece published online ahead of print by the Annals of Internal Medicine.

But that applies only to people who have an established relationship with a primary care doctor, Himmelstein and Phillips said. “We are particularly concerned that abolishing periodic visits might harm vulnerable patients and worsen disparities,” they wrote. The pair noted that virtually all of the studies in the Cochrane review were conducted in European countries where most people had primary care doctors whom they continued to see regularly, while none of the studies included elderly individuals, who, along with the poor, are particularly vulnerable.

“‘Routine’ visits offer opportunities to explore patients’ mental states, glean subtle clues of substance misuse or deteriorating health and form bonds that allow patients to trust us with sometimes painful secrets,” Himmelstein and Phillips wrote.

Now that sounds like the premise for a compelling TV show.

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