Do annual physicals do more harm than good?
Every year, one-third of Americans head into their doctor’s office to be prodded and poked, weighed and tested. It’s a ritual known as the annual physical and is the most common reason Americans visit the doctor.
But more doctors are saying the annual physical is unnecessary — and can even be harmful.
Questioning the conventional
“This specialized visit hasn’t proven anything in terms of staying healthful,” says Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School. Mehrotra co-wrote an editorial in the most recent edition of the New England Journal of Medicine calling the physical outdated. He points out that physicals for healthy individuals can result in a battery of unnecessary tests and visits that aren’t effective in preventing disease.
Instead of using the time for unnecessary processes and exams, Mehrotra argues the same amount of time and money could be better spent targeting patients who are sick and need care.
He says physicals “make sense in theory, but it hasn’t borne out in reality.”
But Dr. Allan Goroll, a professor of medicine at Harvard Medical School, worries that if people skip the annual physical, they lose a key moment to build trusting relationships with their doctors. He penned an opposing editorial saying the issue is not the physical itself, but the way modern medicine is practiced: “It’s a hamster wheel environment. ” He says doctors are rushed to pack in as many assessments as possible and can’t give the proper comprehensive care patients need.
Instead, Goroll argues for utilizing registered nurses and physician assistants to handle testing so primary doctors can focus on providing the care and developing trust with patients. Goroll adds that investing in a patient-doctor relationship also means patients are more likely to follow their doctors’ advice.
Putting patients first, though, may require a change in how doctors are paid, he argues. Instead of looking at the traditional fee for service, perhaps patient outcome should be evaluated instead.
‘Health care isn’t one size fits all’
Still, everyone seems to agree the physical needs an upgrade.
“Health care isn’t one size fits all,” says Dr. Wanda Filer, president of the American Academy of Family Physicians. She points out that guidelines are “across the population,” not made to suit individuals.
“Your risk factor will be different from your next door neighbor,” she says.
For example, she points out that most people begin regular screenings for colorectal cancer at age 50. But if there’s a family history of the disease, a person may need to be screened earlier.
Filer says it’s not about the exam itself, but about having more personalized care.
It’s about establishing a relationship with a doctor who takes into account your personal health history and circumstances and using that to determine what type of care you need, she says. If you’re healthy, asymptomatic, and have no history of cancer in your family, you probably don’t need to take the same precaution as someone who smokes and has a family history of cancer, for example.
Re-thinking standard procedures
Not having an annual physical should not be interpreted as not going to the doctor. Depending on your history and lifestyle, doctors may suggest various interventions and treatments, some of which could be tests that are taken annually. Assessment and management should be based on a personal discussion between you and your doctor.
The American Academy of Family Physicians has identified a number of procedures that have become routine in today’s practices and may be overused. They say patients may want to consider these recommendations before agreeing to these procedures.
1. Don’t use dual energy X-ray absorptiometry, known as DEXA, screening for osteoporosis in women younger than 65, or men younger than 70 with no risk factors. DEXA is not cost effective for young, low-risk patients.
2. Don’t order annual EKGs or other cardiac screenings for low-risk patients without symptoms.
3. Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for noncancer disease.
4. Don’t screen for carotid artery stenosis in asymptomatic patients. Screenings can lead to unnecessary surgeries that could result in harms that outweigh the benefits.
5. Women older than 65 who have had adequate prior screening and aren’t at high risk for cervical cancer don’t need screenings. There’s little evidence of benefit for screening after 65.
6. Don’t screen women younger than 30 for cervical cancer with HPV testing, alone or with cytology. This can lead to more invasive testing and procedures.
7. Don’t routinely screen for prostate cancer using a PSA test or digital rectal exam. PSA-based screenings can result in over-diagnosis of prostate tumors, many of which are benign.