Despite the uselessness of the annual physical, we still have to do them:

True, the very notion of a requisite annual physical is controversial. However, patients appreciate doctors who are meticulous, and patients (and jurors) don’t read medical journal articles advising against physicals. I use the annual physical as a preventive review for my patients to make sure they’re up to date on mammo, Pap, DEXA, PSA, urinalysis, guaiac smear test, colonoscopy, etc.

Preventive care is going to become much more difficult in the era of the high-deductible insurance.

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  • Gasman

    One manner to differentiate the relationship of the doctor with the patient is the manner of payment.

    Capitated patients generate income for the physician whether the patient actually comes to the office or not. The doctor/patient relationship is always alive and well as long as the doctor continues to accept the cash from the insurance company even if the patient never comes to the office for twenty years. As long as the doc is on the annual take for his services then it is incumbent upon him to provider reminders to the patient of reasonable preventative health measures they should consider partaking.

    This differs from a fee for service arangement where it would be reasonable to assume that a patient has severed all continuing responsibility of the physician if the patient and his money stay at home or go to another physician. The doc in this case has no duty to seek out the patient for that long overdue pap smear.

  • Anonymous

    insurances/hmo’s do pay for a “preventive exam”; I use this diagnosis code for when a patient comes in with no complaint and wants “an annual physical”. It is in our interests do to preventive medicine; as we have read over and over, these assholes will sue over missed breast ca, colon ca, heart murmur, whatever. When a patient comes in for a preventive exam, I do a thorough physical and lab work, psa, etc and pray to Go* that I find somehting abnormal; that gives me an excuse to refer to a specialist and cover my ass for a future lawsuit. Anemia = hematology, gi consults; elevated psa = urology consult; heart murmur, chest pain, sob, burping, farting = cardiology consult; then each of these specialist does their own tests to cover themselves; if you guys follow my lead, you will be immunized from a bnig verdict. The problem is when there is nothing abnormal, even then I recommed a cardiology eval for a stress test “because they have never had one, just to be safe”!

  • Anonymous

    Just check their labs; If you do 30 Labs, one is statistically bound to be abnormal. That will give you plenty of reason to refer them to a specialist to share your liability.

  • Anonymous

    Guys,

    I can see why the ER guys might be a little extreme with the CYA, but why are you ordering “preventative stress tests”? Really?

    The correct Zen approach in my mind is to learn the science behind prevention, do it to the best of your ability, and then if the legal profession wants to pick your pocket, shame on them. Their ability to pick your pocket is dependent on a bad outcome not whether or not you ordered a screening CBC on a 25 year old male (which you should not do).
    b

  • Anonymous

    “then if the legal profession wants to pick your pocket, shame on them”

    Yeah that’s gonna work. Sitting at a deposition, with some nose-picking sodomite, and say “shame on you”. The judge would probably throw out the case in a second, with a comment like that. The only answers are DEFENSE and radical political action, like paying off politicians. None of this AMA “patient safety” bullshit that makes physicians look like idiots.

  • Brock Tice

    Why are annual physicals bad?

    This is coming from someone who thought he needed to start getting annual physicals but feels guilty that he hasn’t yet.

    I have some medical background (biomedical engineer, do cardiac electrophys research) but not a clinical background, so I’m not totally clueless but this isn’t my line of work.

    What’s the harm in an annual physical, then?

  • Anonymous

    Brock, I think the doctors here answered your question: if you come for annual physical they’ll order a bunch of useless tests just to protect themselves. At the very least, every test takes your time; at worst you’ll have a false positive or get diagnosed with something that’d never threaten your life and you’ll go throw some unnecessary toxic treatment. Now you may get lucky too, and may benefit by catching something that was destined to kill you “just in time”, but the probability of this is very slim, significantly lower than the probability of harm.

    Apparently studies failed to show that people who have annual physicals live any longer than people who don’t — I’d love to see a reference to these studies, btw, simply to mail to some policy-makers of my employer who make a rebate conditional on “preventive care”.

    This is from someone who’s been going for annual physicals but now, having done some reading is seriously considering to forgo them. My blood pressure goes up 20 points during doctor’s visits – all the way from perfectly normal to high, so I figure this is more harmful for me than any benefit I can get from the visit. Of course, it means I’ll have to schedule a dermatologist visit to get my ecsema cream refill, but it might be worth it.

  • Brock Tice

    Ah, defensive medicine and the litigation that encourages it rear their ugly heads again.

    I simply thought, “what can be the harm in having your vitals checked regularly,” but didn’t take into account the defensive stuff.

    I thought I was missing something else, which is why I asked. Maybe I should just go to the drug store and use the pressure cuff every once in a while. :)

  • Anonymous

    Brock, don’t let these anonymice physicians make you think their actions are the norm or that they have any legitimate justification for them. Many physicians are actually still professionals, and not merely people with medical degrees.

  • Anonymous

    brock, you’re an idiot…see you in the office!

  • Brock Tice

    “brock, you’re an idiot…see you in the office!”

    And why’s that, exactly, Anonymous?

    I’d like to see what Kevin has to say about this. I mean, generally, you’d think it would be a good idea to do routine checks of the basics. I’m inclined to think that GPs would agree if they weren’t worried about covering their asses, right?

    By the way, if you’re going to call me an idiot, how about:
    (a) backing it up and
    (b) having the balls not to do it anonymously

    Thanks.