Why Your Doctor May Want You to Skip Your Annual Physical

woman waiting in an exam roomAn annual physical is the most basic, preventative medical practice out there. Why wouldn't someone, unless they didn't have health insurance, want to have that annual check-in to make sure they're physically firing on all cylinders? After all, for many people who don't see their doctor regularly, an annual physical may be their only opportunity to make sure they're well and stay well. But experts are now suggesting we do away with the routine exam entirely.

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"I would argue that we should move forward with the elimination of the annual physical," Ateev Mehrotra, MD, a primary care physician and professor of health policy at Harvard Medical School, tells NPR. "When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm attacking moms and apple pie. It seems so intuitive and straightforward, and [it's] something that's been part of medicine for such a long time."

Nonetheless, Mehrotra says people really only need to go to the doctor if something is wrong or if it's time for a preventive test like a colonoscopy, citing randomized trials going back to the '80s that don't support physicals.

But that's not the only gripe. Obviously, cash rules everything around us, and it's most definitely a reason doctors like Mehrotra would discourage people from opting for preventative medicine over reactive treatment. (Along with false positives, which they claim could unnecessarily scare a patient. Eye roll.)

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Mehrotra even admitted that each visit usually costs insurers just $150, but since so many people get them, that adds up, and the estimate is that physicals cost about $10 billion a year, which is more than we spend as a society on breast cancer care.

Oookay. So, if people skip physicals and just wait around for symptoms to crop up and are diagnosed with a preventable disease, how much does THAT cost?

As Mark Caruso, MD said to NPR, "I think having a look at somebody is worth its weight in gold." He went onto explain how he could very easily have a patient come in with a lump or bump that wasn't right, or a spot on his chest that could turn out to be a melanoma discovered early.

Clearly, doctors aren't all on the same page on this potentially divisive topic. Anita Varkey, MD, internist at Loyola University Health System in Maywood, Illinois tells us, "While it is true that research studies have not shown that scheduled general health checks without a specific cause including the 'health maintenance' annual visit, do not reduce morbidity, mortality, or hospitalization, and create a potential for harm from unnecessary testing, it may still have a role in medical care." 

She explains what research can't exactly measure intangible benefits of physicals like their ability to bolster trust and support between you and your doctor. 

However, patients who have several chronic medical conditions and see a doctor regularly for management may not need annual physicals, because most physicians will ensure that the patient is up to date with preventive measures along with managing their ongoing issues, Varkey says. (Though, you may need to ask and make sure your doctor is looking at your long-term health in addition to your current picture.)

What about the rest of us? "Most patients will fall inbetween the two spectrums of chronically ill and exceedingly healthy," Varkey explains. "And I think it is reasonable for most adults to have a primary care physician that they see once every couple of years to stay up to date with health maintenance, which includes age-appropriate cancer screening, immunizations, and testing only if indicated based on history or physical exam findings."

That said, everyone has different personal health history and needs. So we'd all do well to talk to our doctors and determine the the frequency with which we should check-in. 

If you're not sure how frequently you should have basic preventative tests and exams based on your age, the National Institutes of Health provides guidelines for women 18-39 and 40-64.

How do you feel about annual physicals?

 

 

Image via iStock.com/fstop123

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