Are annual physicals useful?


I am one of those people fortunate to be covered by an employer-based health insurance plan that pays for an annual physical exam and I regularly schedule one because it seems like a good preventative way of detecting early problems. So I was surprised by this article by Ezekiel J. Emanuel, an oncologist and a vice provost at the University of Pennsylvania, who says that large longitudinal studies show that routine annual physicals are of little value and his new year’s resolution is to stop having them.

The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.

This lack of evidence is the main reason the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services — does not have a recommendation on routine annual health checkups. The Canadian guidelines have recommended against these exams since 1979.

Emanuel says that screening everyone is not an effective way of treating disease.

If you screen thousands of people, maybe you’ll find tens whose exams suggest they might have a disease. And then upon further tests, you’ll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis.

The others may have discovered a disease, but one that either would never have become clinically evident and dangerous, or one that is already too advanced to treat effectively.

Emanuel says that not all preventative measures are of no value.

My New Year’s resolution does not mean I won’t get my annual flu shot or a colonoscopy every 10 years — or eat a balanced diet and get regular exercise. These are proven to reduce morbidity and mortality.

Kevin Drum says that he never went for routine physicals and none of the many primary care physicians he has had over the years has ever recommended that he do so. Come to think of it, my primary care doctor’s have never done so either, though they have not discouraged it, and if I delay scheduling one, I never get a reminder from them the way I get from (say) my optometrist.

Is the routine annual physical like drinking eight glasses of water per day, something that has gripped the imagination of most of the public even though its purported benefits are non-existent?

Comments

  1. carbonfox says

    I’ve long suspected that annual physicals tend to have little to do with improving health and more with supplying clinics with dollars.

    Unfortunately, my doctor is one of those who holds oral contraceptives hostage to an annual physical–including a Pap smear (which I find traumatizing as an assault survivor, requiring days or weeks to recover from the anxiety), even though my risk for cervical cancer is a fraction of a percent given baseline statistics tempered by vaccination, my medical history, and my boring lifestyle. Sadly, barrier methods aren’t an option for me as I need hormonal therapy to control my PCOS, so every year, I find myself forking over cash in exchange for the privilege of spreading wide so a stranger can dive his hand into my genitals. I suspect many women suffer through needless annual exams just to obtain oral contraception, which should probably just be available over-the-counter.

  2. smrnda says

    @carbonfox

    I’m guessing that you don’t have the option of seeing another doctor. Forcing you to endure a traumatic and invasive examination when the risks are minimal (and the risks of the Pap smear for your own mental health are significant) seems like downright abuse by a health care provider.

  3. Mano Singham says

    When you have the ‘fee for service’ model as in the US, this encourages doctors to do more things.

  4. says

    Annually is probably not the answer, but periodically certainly could be. Certain ailments appear most often at certain ages (e.g. various types of cancers, heart disease). Pre-emptive and predictive medicine could more effectively target such conditions.

  5. Al Dente says

    Unfortunately my company’s health insurance provider insists on annual physical exams. If I don’t have a physical exam then next year my insurance co-pay essentially doubles.

  6. machintelligence says

    I suspect that the value of periodic physicals goes up as one ages. I never had an annual physical before my late 50’s when I noticed my blood pressure was creeping into the elevated range. A decade or so later I have one mostly to monitor the effects of the medication to control it. Annual eye exams on the other hand are a necessity, since there is a family history of glaucoma and macular degeneration.

  7. questioningkat says

    My workplace also requires annual physicals. Since my doctor retired, the Clinic charged a new patient fee on top of the free annual. For what? Telling them my history so that they could code it to substantiate/justify the $180 cost. My annual mammogram also showed suspicious results – not uncommon with my fibrocystic breats – I go through this every year. Going to a new facility; their procedures were a bit different. I could see the dense whiteness of my mammogram, but not an explanation. Never before did it show up that clearly without an ultrasound. I received a letter and call to get anther mammogram. I had to wait nearly a month and finally couldn’t take the stress and found a way to get an appointment the next day. Same results and then they did an ultrasound. With my co-pay and deductible I had to pay $2,000 to find out that I’m OK and just needed a couple refills. Yet, I have a few ongoing orthopedic problems that no doctor has been able to resolve. I feel as if it’s money wasted and would rather save it for the day when science has figured out some actual answers.

    Frankly, I think this idea is stacked in the favor of employers. Yes initially they pay, but HR also gets bills for any follow-up. I’d hate to be suspicious, but I believe this would lead them to find ill employees that are expendable.

    I really wish my health care wasn’t tied to my employer. They are now taking an active part in my weight, eating habits, excercise…all under the guise of a “wellness program.” “If you excercise 3x a week we will give you money back.” “Agree to this high deductable program and we will give you a little money…” Eventually you realize the money given is still less than the money you’ve spent for healthcare. I’ve never felt so ill and stressed before.

  8. Mano Singham says

    People are beginning to cotton on to the fact that some of these wellness programs are being used less to improve the health of employees and more to fob off some of the costs of health insurance onto them.

  9. anat says

    My husband went for his annual physical. He was surprised the doctor did not want to do blood tests, as they are recommended annually for his age. The doctor said that last year’s tests were good and he was not overweight, so he didn’t need new tests. My husband was surprised: How were they going to detect a change for the worse if they just assume he was doing OK? Eventually he got the doctor to approve the tests, though under protest: she claimed my husband was abusing the system. He might need to look into private testing if he remains ‘low-risk’.

    I am aware of a pilot study where a group of people (mostly middle-aged) receive detailed blood tests every 3 months accompanied by personal coaching and they have been able to give personal recommendations for most participants to achieve things like reduction in inflammation markers, reducing blood mercury (don’t eat too much tuna!), weight management.

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