Why the annual physical exam is essential to both doctors and patients

I have listened to health economists debate the value of an annual physical exam.  Is it cost effective?  Does it prevent disease?  It doesn’t matter.  It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history and physical exam and use the data to coordinate a care plan for you which is personalized.

The history of present illness illustrates any immediate and current concerns. The past history reviews previous illness and how those problems may affect your current and future health. A family history presents genetic data which may affect you and your loved ones in the future. It updates your physician on what changes have occurred in your family’s’ health that may affect you. The social history looks at your school and employment history as well as lifestyle choices. Are you working with industrial toxins or in a field prone to certain predictable and preventable disease?  Are you smoking?  How much alcohol is in your diet? Are you partaking in physical exercise?  Are you in a stable relationship?  All these factors influence your health and choices.  Do you have a living will?  Who is your health care surrogate and who are your emergency contacts?  It is a great time to review your allergies and medications both prescription and over the counter vitamins, minerals, herbs and supplements.  Last but not least we look at checkups, vaccinations and immunizations.  Are you current on tetanus shots?  Do you know about pneumonia vaccine and zostavax for shingles?  Have you had your eyes checked for glaucoma?  When did you last see a dentist?  What about skin checks, colonoscopies, mammograms, pap smears and bone densitometry?   The history session ends with a complete review of all your body systems. By asking a laundry list of questions we hope to jog your memory to discuss all those little items you meant to ask about but may have forgotten to bring up.

The physical exam is used to support the hypothesis and answer the questions raised during the history taking session. It should be thorough looking at you from the top of your head to the bottom of your feet without skipping any orifices in between. The findings of the exam, coupled with the history session, will determine which laboratory tests, if any, your doctor will choose to order.  In thirty years of practice, I am rarely surprised by the results of a blood test if I have done a thorough and complete history and exam. Patients seem to feel something magical about lab tests but the truth is that a thorough and experienced clinician usually knows what the findings will be before he orders the test.

The complete exam should be followed by a consultative review session during which the doctor explains the findings of the history, exam and lab and makes suggestions. A care plan should be established at that session and a defined follow-up plan suggested and scheduled.

During your physical exam the doctor is learning a great deal about you. From the way you dress, to the way you carry yourself to your speech pattern; the physician is seeing you while you are healthy. It is much easier to diagnose a problem if you have had the opportunity to see the patient when everything is normal.  This knowledge of your normal appearance is what allows your doctor to find a problem in its initial stages rather than a crisis requiring a visit to a hospital emergency department. It is all part of the concept of longitudinal long term care and relationship.

Find a doctor. Schedule your yearly checkups.  If you find a physician you trust and respect stick with them. It may save your life.

Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.

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  • Finn

    I agree wholeheartedly about the importance of annyal physicals, particularly as we get older. 10 years ago I could keep my entire medical and family history in my head, except for immunization dates, which I kept in the same little blue book that my mother recorded my childhood immunizations in. But within the past decade I’ve developed cancer, osteoporosis, and chronic insomnia, had surgery, learned that I carry a BRCA gene, and watched new diseases crop up in my family.

    I do have a small quibble, though. Since every practice I’ve been in expects me to be gowned and perched on the examining table before the doctor enters for my physical exam, there’s no way they can make any assessment of how I dress or carry myself because I don’t normally sit on tables nearly naked.

    • Fam Med Doc

      “I do have a small quibble, though. Since every practice I’ve been in expects me to be gowned and perched on the examining table before the doctor enters for my physical exam, there’s no way they can make any assessment of how I dress or carry myself because I don’t normally sit on tables nearly naked.”

      Well, not every practice. I first start EVERY encounter with a patient in my personal office (you know, the one w my desk, my bookshelves etc) & take a history there with both patient & doctor facing each other in comfortable chairs & my desk behind me- not in between us. THEN I take the patient to the exam room next door, have him/her disrobe if necessary & do the exam part. When that is done, I return back to my office & start my charting, writing out prescriptions ect while the patient gets dressed & returns back to my office. Then I do the teaching ect to the patient in my office. Face to face.

      I agree with you. I feel waiting in a cold, sterile exam room, naked except for a gown is humiliating & dehumanizing. I refuse to do it for myself & I don’t ask my patients to do it. Look around for docs who do this also, Finn. Surely I can’t be the only one who does this.

      I know I sound sorta nauseatingly self-congratulatory but I really do this. Any other of my colleagues out there who do this too?

      • Debra

        You sound like a good doctor.

        I’ve learned to do this as a patient with much success: Once I am left in the exam room to wait for the doctor I don’t put on the gown (it is rarely necessary to disrobe), don’t sit on the table, and don’t even use the chair. When the doctor comes in, I greet him fully clothed standing up with a handshake just like would happen at the beginning of any normal business encounter. When we discuss things, I sit in the chair unless there’s a need for a physical exam.

        One of my doctors uses thick cotton color gowns that are worn like a wrap dress. Not sure how men feel in it, but as a woman it’s not so bad. I have dresses in my closet in the same cut!

      • Miranda

        I don’t have people meet in my office, but I do have people undress before we talk. And I usually do my annual exam over two visits. Patients seem to like going through there lab results one by one. The problem is billing – if I bill the first visit as the Preventive Visit and all of the labs are normal, there’s usually not a code to justify the second visit.

        • Miranda

          Sorry, do not have people undress before we talk. Should try to do only one thing at a time :)

  • Bill

    How does one do all of this in a 15 min appt? Although would be ideal, not quite realistic.

    • http://patientprivacyreview.blogspot.com/ Joel Sherman MD

      The author has a concierge practice. His restraints are very different from the average doctor who say works in a group or clinic.

  • Leslie

    I do not doubt the importance of an annual exam for one’s health. But I question it as a means of establishing a quality relationship. You just can’t have much of a relationship with anyone you only see yearly for 15 minutes.

    BTW, I have never once had a primary care doctor ask me to book a follow-up visit after an annual exam. That would be nice.

  • http://kckidsdoc.com Natasha Burgert

    I would add another very important part of the yearly exam is relationship building. Building a relationship with a healthcare provider during times of wellness is like “putting money in the bank” for times of illness. During the stress of a new diagnosis, having a provider who knows you well, and can be an active advocate for your care, is optimal. And the better a provider knows each patient, the easier it is to develop appropriate, realistic, and compassionate care. Get those checkups!

    • e-patient

      I find it odd to spend all that money for relationship building. Why not pay doctors to go out and have a beer?

      I question the value of that relationship. My PCP might get to know me during that physical but chances are that information will not help during an emergency when I go to the ER. It won’t help during an urgent situation when I see the nurse practitioner. It won’t help during a complex issue when I see a specialist. So what’s left?

      • Fam Med Doc

        Not true. In my practice, there are no mid-level providers, only me as your doctor cause im in solo practice. In regard to specialists, I send my patients to the doctors who I feel are the best, specialists I would go to myself with the same problems. And I call them personally, I have most of their cell phones numbers, and give them the medical history of the patient I’m sending. I know my patients really, really well- not only their health problems, but their medications, what they do for a living, marital status, even if they are gay or straight. And if you go to the ER, if you give the doc my phone #, s/he can call me & get the scoop cuz I’m on call for myself 24/7 cause I rarely take vacation.

        So, it does pay to have a primary care physician. It really does.

        • e-patient

          Not true? It’s true for many practices.

      • Sarah

        It seems that if you have a better relationship with your physician, you would feel more comfortable sharing information that you may not share with another. That’s just me, maybe.

        • e-patient

          An intimate caring relationship with your PCP is meaningless when you are sitting with the nurse practitioner who you have never met.

          • Fam Med Doc

            Dear e-patient,

            I agree w your comment. My suggestion: call around & look for a doctor in solo practice. Go thru the list offered by your insurance company, it’s probably available online, & call up & ask each offices receptionist, “do you have a PA or NP who works in the office also?”. Cross off the ones that say yes. It just sounds like you really don’t wanna to work w a mid-level provider and you know what? Neither would I.

          • e-patient

            I don’t mind nurse practitioners. I mind being passed around the office.

            The only doctor that practice solo is concierge. I don’t have the option to pay $3600 on top of my insurance premiums unless I want to use my son’s college fund.

  • Leo Holm MD

    “Is it cost effective? Does it prevent disease? It doesn’t matter. ”
    What?
    Why would a patient participate in something that does not prevent disease and is not worth the money they spend?
    What is it about being a human being that necessitates examination by a physician?
    Why does the earth making another trip around the sun mean its time for another appointment?
    Why do physicians charge for information that could be made readily available to people as in a public service announcement?
    I am all for the doctor patient relationship. But call me when you need me…not the other way around.

  • Carrie

    The visit as described does sound nice.

    One problem is that many primary care providers have to deal with both of the following constraints: 1) time and 2) mandates for what gets covered in a “high quality” visit, often leaving little if any time to discuss what actually concerns the patient.

  • Debbie

    Well said.

  • Claudia

    I would strongly discourage everybody from going to annual exams because all the doctor is doing is scouting out “pre-existing conditions” for your health insurance. That’s why there also in reality never is a follow-up visit.

    When you get really sick and need treatment, the health insurance payment denial specialists will sift through your annual exam reports and interpret every little thing as a sign of your condition already existing back then… and with your blue-eyed faith in your “doctor” you delivered them all the necessary data yourself!

    • Primary Care Internist

      I am not one to defend insurance companies (on the contrary i feel quite screwed by them generally). But FYI I have NEVER had an insurance company review my patients’ annual physical records for pre-existing conditions in order to deny treatments. The denials seem to be automated, and based primarily on the procedure to be performed (eg. MRI, specialist consultation, hospitalization, etc.- weight loss surgery e.g. is a biggie)

      but i’m also all for paranoid conspiracy theories, which can be fun

      • Leo Holm MD

        The insurance companies can learn quite a bit just based on claims data. EMRs will make it worlds easier to troll patient data as well. If that doesn’t work, a “disease management” nurse may call you and directly ask for your clinical data. I receive insurance company forms all the time asking directly for patient data, asking me why I haven’t gotten a HbA1C on my diabetic patients yet, asking why my patient is not on a statin. How do they know?? Dont kid yourself…they are watching you like a stalker.

  • Justin

    It would be nice if insurance would pay for a 30 or 60 minute exam for the annual physical, but it sounds like they do not (which surprises me because I thought they paid for at least 30 minutes). If it was me, I would pay for it out of pocket to have that much time with undivided attention from my physician.

  • Richard

    The annual physical exam is an appointment requiring more time which would be scheduled at the time the appointment is booked. Primary care physicians should have slots available for these longer appointments. A nurse can gather some of this information prior to the appointment just as they always check blood pressure, pulse, etc before the doctor comes sailing in, anyway. It is perfectly possible to do all this if the doctor cares enough to do it. Most diagnoses are made by listening to the patient, not by lab tests. It’s part of the job, busy Family Practitioner or concierge doctor – It’s part of the job.

  • rich md

    My favorite is when after the 15-minute “physical exam”, the patient says, “that’s it?”. They inevitably have a friend who had the “executive physical” which includes a stress test/echo/carotid doppler/ct scan of the whole body, and chest x-ray. Then I spend 5 minutes explaining to the patient why none of these tests is necessary and their insurance will not pay for them anyway, the risks of false-positives, etc…

    what a job!

  • Penny

    I’ve never understood the value of a physical examination either. If there’s something wrong, I go to the doctor so he already knows what’s wrong. I especially hate pap tests because that’s most likely the time when women finally have the courage to ask their doctor personal things about their bodies. The bad part is that the doctor doesn’t come in before the patient has stripped. He shows up with a nurse to do the exam and that’s the only time the patient has to ask the questions she has been waiting to ask for the entire year.

    That means that the patient now has to share personal questions with two people versus one and is far less likely to ask, even if the other person “is” a nurse. Every patient knows that the “more” people they share their questions with, the more likely they are to be repeated, whether shared with professionals or not. So Sarah and Finn’s comments did hit a chord with me.

  • solo fp

    A 15 minute routine office visit is around $70 with Medicare and around $60 with HMOS. An annual physical is around $85 for an established patients. It is less documentation and more profitable to see two patients in the 30 minutes that it takes to do a physical.

  • Family Medicine Doctor

    dear e-patient,

    well, you know saying “you get what you pay for.”

    the reality is primary care docs are all struggling financially and gotta see alot of patients just to pay their overhead. and some use, not appropriate in my mind, mid-levels to help pay their bills (the insurance company pays for the visit done by the mid-level at the same rate a doctor would get paid, but the doc pays the mid-level less than the doctor would have to pay for a real doctor associate, so the doctor makes some profit and in primary care that small profit is essential to some to pay the bills).

    so like is said, you get what you pay for.

    but im in solo practice and NOT a concierge practice, and i dont have a mid-level working with me. and i know tons of docs just like me in my city. surely theres gotta be some nice doc near you in solo practice. maybe it will take some phone calls to find him/her, but i suspect there is one out there who love to take care of you. good luck in your search.

    • e-patient

      I live in a town with 13 family physicians that except my insurance. The is the additional doctor who has a concierge practice and one nurse practitioners that practices independently. One clinic is satellite of a big medical center in a nearby city, one clinic is a doctor owned mulitspecialty clinic and the third is a group three doctors. The the medical center and the small group use nurse practitioners for urgent care and the multispecialty group has their own urgent care center staffed by doctors-which means a stranger is taking care of my urgent needs. The only option for a solo provider is the nurse practitioner.

      My health is too complicated and doctors don’t really have the time to “take care of me.” When I got sick, my acute symptoms were sent to urgent care. I suffered for two years because no one saw the big picture. No one saw how it affected my life. I now coordinate my own care. As an e-patient, I already know more than my doctor about diet and exercise, know what screening tests are recommended, seek out my own specialists when needed.

      I partake in an annual physical exam to renew my presciptions, get a pap if needed and get a order for my yearly labs. We have just enough time for this. A relationship isn’t necessary. My doctor knows my marital status, my occupation and my sexual orientation because those questions are on the intake form.

  • Fam Med Doc

    Dear e-patient,
    Sorry to hear about your health problems. Yes, in a small town it can be challenging to find a good doctor. But maybe in a larger city next to town a good doc could be found. Some docs are worth the drive.

    But I have some concerns. You wrote:
    “… I already know more than my doctor … seek out my own specialists when needed.”
    You should be careful when trying to be your own doctor. You might miss something & end up hurting only yourself.

    Warmest regards & best of luck in all health related concerns

    • e-patient

      I have been an athlete since I was 12 years old. I have studies many training principles and lived them. Several years ago I purchased a heart rate monitor and asked my doctor about maximum heart rate. 220-age. Not a very good predictor of MHR, especially for an athlete. I don’t ask those type of questions anymore. My doctor also failed to correctly diagnose a skelatal problem and the lack of treatment has left me with a permanent disability. At the time I trusted my doctor. The doctor missed something and I was harmed. I am currently working with a functional movement specialist and my pain is at manageable levels without the need for medication.

      Of course during the physical above exercise means “do you exercise 3 days a week?”

      When I got sick, one of the symptoms was weight loss. Not one doctor I saw suggested dietary ways to stop the weight loss. I did my own research, changed my diet. I currently grow my own vegetable, get what I can’t grow from a local organic farm. I am a vegetarian and no doctor has ever talked to me about iron or B-12 or even if I am getting enough protein.

      Of course during the physical above diet means “do you eat a low fat diet so you can lose weight?”

      I find the greater threat the doctor not truly engaged in my health. I see my doctor regularly and answer any questions, report any changes. I just don’t expect quality continuous care and I make sure I get the care I need. I don’t need a relationship for that.

  • Beth

    While I appreciate all of the concerns that have been expressed here, both by physicians and non-physicians, I would like to say, as a registered nurse, that the assistants in physician offices to whom you are referring as “nurses” are not nurses, they are Medical Assistants. I have a Bachelor’s degree in Science. A Medical Assistant did at most, 12 months of training at a community college level. Please don’t confuse our educational preparation or skill level.

    Second, primary care physicians make approximately 60% of what a specialist physician makes, and is typically on-call for extended hours, vs. the specialist who does’t take call past 5:00 (or sometimes 3:00) or on weekends. So, yes, it’s unusual to find a primary care or family practice doctor who doesn’t need to see at least 4 patients per hour in order to survive financially. (Please remember that most physicians graduate with enormous student loans!)

    I’m fortunate to have a very smart caring PCP who does spend an hour with me on the rare occasion I’m in his office. Yes, he does know me. But I have no idea how he stays afloat financially with all the time he devotes to his patients. I applaud him and wish that our healthcare system were structured to support him instead of showing such unmerited favoritism to the spcialists.

    Ultimately, we cannot afford the disjointed, wasteful, unsafe, error-ridden, ineffective healthcare system that we have in place. I can’t think of another industry in this country that would have or has survived making all of the mistakes that our healthcare system has. (And, no, I am not a fan of Obamacare even though I did vote for Mr. Obama.)

  • Fam Med Doc

    Dear Beth,

    You might as well be one of my patients in my office. You described the issues perfectly:
    “Yes, he does know me. But I have no idea how he stays afloat financially with all the time he devotes to his patients.”

    Well, I don’t know how your doctor stays afloat cuz I’m just about under water. It’s really bad, worse than you even described. And nothing is going to change, Obamacare or not.

    Hold onto that doc. He sounds like a winner.

  • Mark

    I think annual check-ups are of greatest benefit to patients who are in good or decent health.

  • Penny

    Actually I find it kind of scary in Canada hearing the words
    “you get what you pay for” for medical services. We aren’t quite as bad as Americans yet, in the fact that our medicine isn’t yet thought of as being just another ice cold corporate service, although we have started to head there with the introduction of private/public practice.

    Now all hell has broken loose and doctors have lost much of their authority. The only doctors who take patients these days are those from foreign lands who have less than 5 years of service and increasing numbers of people don’t have any doctor at all.

    Don’t know where all the traditional home country doctors have gone but they simply aren’t signing up. Since the changes have been made, they’re seemingly disgusted with their profession and their morale is ultra low. My doc who used to love his job now appears to hate it. I suppose that’s the way the government wanted it. They seem to want to eliminate medical care for everyone but themselves with their big fat taxpayer provided medical plans allotted to themselves.

    Sure hope Obama care isn’t planning on modelling your system after ours because that would be a true negative. Medical care has never been worse . It’s becoming more cold and American every day. It’s true that more patients are now turning to e-care and getting their advice often even other patients who seem to be able to help them far more than doctors.

    It’s so sad to see such destruction in our country. I’m sure that today most doctors wish they had taken up carpentry instead. At first more people started signing up as dentists but now we are literally drowning in dentists.

    After having lived in Germany for a few years where they had one of the best medical services in the world with benefits unheard of in our countries, I can’t understand why Canada or the US can’t duplicate that. Guess we just don’t have the brains. Each time we try, we somehow exceed our previous failures.

  • Jean

    Personally I do not understand why people feel the need to see a doctor every year when they are healthy! A lot of things that can be done to maintain good health are life-style related and that information is readily available without a doctor having to fill you in: you just have to be willing to commit to taking care of yourself on a daily basis (eat right, exercise, don’t smoke, etc.). I can understand the desire to establish a relationship with a doctor but in most cases once a problem crops up you are referred to a specialist who you do not have a “relationship” with. And a lot of minor problems, like colds, don’t really need a doctor’s attention, contrary to what many people think. We have been oversold on seeking medical treatment, in my opinion, and have turned into a bunch of “worried well”. I also think this has contributed to our increasing health care costs: people overusing the system. I only see a doctor when I’m sick/symptomatic, as I think it should be. If you are in tune with your body you will know when things aren’t right and seek help then. Otherwise you are just paying someone to look you over every year and tell you everything is ok. A waste of time (and money) in my opinion.

  • Elizabeth (Aust)

    Jean, I totally agree…
    I’m Australian and 53 years old – the thorough physical (yearly or otherwise) is not part of my healthcare. When we hit middle age, many of us see a Dr every couple of years for blood tests to check cholesterol levels etc (not the unreliable CA125 blood test!) and for a blood pressure test. Others have cancer screening…
    I personally regard cancer screening as elective, which is novel for a woman, because we’re supposed to submit to all and every demand for screening. We’re counted like sheep.
    I think screening has been oversold to us and is more likely to harm us. If people want to screen, so be it, but even they should be protected from over-screening and inappropriate screening and should receive honest information on risks and benefits. Our cancer screening is highly political, emotive and generates lots of profit. Our doctors even receive undisclosed target payments for pap tests.
    If a Dr or pathologist looks at enough parts of your body, they’ll find something “abnormal” and then you move along the diagnostic track…you can end up in some very ugly places. Over-diagnosis is a hidden, but very real concern in breast screening.
    I don’t wish to be treated for a cancer that would never have bothered me or be left injured after unnecessary procedures and over-treatment and I hate to see the anguish and fear false positives cause to members of my family and friends. I really can’t see the value of these fishing expeditions on the healthy body.
    Dr Gilbert Welch is on the right track….I just read his book “Over-diagnosed”….the things we don’t know can harm us, really harm us!

  • Jean

    Elizabeth,
    I am so glad that there are other women out there (even if not many in the good ole U.S.A.!) that feel the same way I do. So many people just go along with whatever the media, doctors, etc. “advise” and never look into things for themselves. They don’t listen to their own bodies or take care of them for that matter. When did healthcare get to this point? I am 58 years old and was brought up to see a doctor only when I need one (when sick). Thank goodness I had a sensible mother who never sought the usual medical care even during her late years: no PAP smears, pelvic exams, mammograms. She lived to be 84 and just died in her own home of a stroke: not a bad way to go. I have also read books by Dr. Welch and he is right on in my opinion, also. I only hope if and when I need a doctor I will be able to find one that has as balanced a view as he does. I fear that won’t be too easy. Thank you for all your posts on this blog and on Dr. Sherman’s.

  • Elizabeth (Aust)

    Jean,
    I really hate to see the damage done to women in the name of “preventative care” and because of decades of pressure and deception, even women harmed by over-treatment walk away “grateful” they don’t have cancer. IMO, it is a frightening and cruel cycle. I watched an episode of one of your medical programs recently and the doctor was urging women not to neglect their routine pelvic exams. Lots of women in the audience were taking notes. I couldn’t help but view this man as a snake oil salesman – he must know the exam is unhelpful and risks your health. Rather than continue the old and profitable deceptions, ethical doctors need to come clean, stand up for women – thankfully, doctors ARE starting to do that in the States. Dr Carolyn Westhoff has made some honest comments recently in, “Questioning the value of the routine pelvic exam” but while you have doctors selling fear and misinformation to maintain highly profitable practices, many women will continue along the old path. I know some American women are fearful if they don’t have these exams, they need the false reassurance.
    I’m hopeful more women are starting to see the light – never before have I seen so many negative comments about cancer screening in this country and the numbers screening are falling…
    I know the screening authorities are scrambling to adopt some new and unethical ways to “capture” women. It disgusts me. My grandmothers also rarely saw doctors, both died in their 80′s.
    I think this is a very important subject – so many women are worried and harmed and very few are giving informed consent, so I set aside time to post and send off emails and letters. Censorship has always been used to protect the screening programs – that’s becoming less effective though with more women becoming aware of the facts. It’s getting harder to keep women in the dark and “compliant” – more women are taking control of their bodies. That makes me very happy…

  • Penny

    Thanks Jean and Elizabeth. I think you’re speaking for the great majority of women who are now indeed waking up and are starting to object to being herded into radiation farms as if they were unsuspecting cattle. And yes, it “is” disgusting that they deliberately keep women in the dark about so many things such as the implantation of titanium chips and the amounts of radiation they are exposed to.

    I especially despise the fact that they describe radiation sessions in the form of “lovely trips.” Every single woman should be educating as many women as they can, to teach them to ask for “actual radiation measurements” versus baby talk.

    Half of the time the techs themselves don’t even know, but anything better than the “trip BS” would make women feel more assured that they might have at least a clue of what they were doing. (It’s especially horrible that so many people (including doctors even), are totally unaware still of the dangers of cat scans.)

    Furthermore with the kind of treatment that women’s breasts are exposed to through crushing mammograms and extremely brutal processes of biopsies and preop procedures makes women feel they are actually promoting cancer versus preventing it.

    Same thing with men’s prostrates. When a relative told me he had 23 biopsies on a prostate the size of a walnut I was so shocked I couldn’t believe it, and later found out that that horridly brutal process was common too. One day I think we will all look back at this with the same horrors we now look at the old ways of blood-letting.

  • Jean

    If you visit Dr. Sherman’s medical modesty blog (women’s privacy section) you will see a new link to the latest recommendations about pelvic exams. Obviously opinions are changing about the value of them in asymtomatic women: they are worthless. I just find it so sad and frustrating that so many women dutifully report for these “well women” exams every year without questioning their validity. Why cannot doctors access each patient based on that individual’s needs instead of recommending the same thing for everyone?? And give them all the facts on risks, benefits, etc. for all these “required” cancer screenings. I still think that we would all be better off if we just saved doctor’s visits for when we are truly ill. The medical profession always gives statistics for lives saved from cancer screenings but I think some of that is misleading: a lot of lives are probably saved because treatments have also advanced and not only because of early detection. Statistics are very nuanced and have to be looked at with a critical eye: they can be read or skewed to sound better or more significant than they acutally are.

    As far as spreading the word to women, I have talked with a few and they are so “conditioned” into thinking pelvic exams, PAP smears (regardless of their personal status, i.e. in a long term monogamous relationship, total hysteremtomy, etc.) mammograms, etc. are necessary that they sort of look at me like I’m the crazy one. They are not willing to look outside the box, so to speak, and research/advocate for their own health. I do, however, know some women who, like me, have never bought into the whole exam/screening thing so there are some of us out there. It will probably take a long time for the medical community and public to change their way of thinking on these matters, no matter what the research shows. The exams are, after all, a money making machine, especially for gyns.

  • iron lung

    So much for evidence-based medicine. There does not seem to be one iota of actual evidence presented in this article that demonstrates actual benefits of an annual check-up.

  • Bob M.

    This post makes a case for conducting physical exams, but I don’t see much justification for the “annual” physical exam. I think the frequency of the preventive physical exam should depend on the patient’s health and risk profile. Why should a healthy 25-year-old male, for example, seek annual physical exams? In many cases, risk — absent of symptoms — does not change much from year to year.

    Evidence-based preventive services are essential. But excessive preventive services potentially turn healthy people into patients.

    Despite the absence of evidence, a majority of primary care physicians do advocate the annual exam. However, they cannot even agree on what the annual exam should include. The notion that physicians are learning a lot from how you dress — while possibly true for the author of this blog and a handful of other doctors — strikes me (with all due respect) as far-fetched. And if a physician isn’t even going to collaborate with the patient to customize a preventive exam schedule based on the patient’s circumstances (as a previous commenter suggested), then what’s the point of getting to know them so well at the initial exam?

  • http://twitter.com/DrPlumEU David Lewis

    There is no evidence that the annual health check provides any health gains for doctor or patient.  This essay is full of misconceptions and myths perpetuating the old ‘them’ and ‘us’ mentality of yesteryear.  Modern medical practice in UK is better than that.  Perhaps this is because we have a robust primary healthcare system (at the moment) which is free at the point of care.

    However, one group of people do benefit from the annual health check – folks with learning disability http://www.ncbi.nlm.nih.gov/pubmed/16901294  This group of patients can sometimes pose challenging health problems.  They are often, if not always, vulnerable adults.  Societies try to hide them, if not kill them.  In a modern healthcare system people with LD deserve regular checkups because they do not often know when they are ill.

    In general, people without LD learn how to access healthcare (should that be ‘diseasecare’?) and many do so.  A truism is that were everybody with ‘diseasecare’ needs aware of the need, healthcare systems would be bankrupted.

    So, Dr Reznick, thanks for nothing.  Writing to encourage more people to pitch up to PCPs for healthcare issues is NOT in anyone’s interest, least of all our patients.