Should You Skip Your Annual Physical?
The annual physical exam, with its laundry list of standard, one-size-fits-all tests, is a comforting ritual for many. And why not? Doesn't it help you live longer and healthier?
Not necessarily, according to a new review. Researchers analyzed 14 studies of physical exams including more than 180,000 people and concluded that annual physicals don't lengthen life. They don't reduce the chances of dying from heart disease or cancer, even though some of the tests used in the physical target those ailments.
"In our review, we could not find that," says researcher Lasse Krogsboll, a PhD student at the Nordic Cochrane Center in Copenhagen, Denmark. What's more, there may be some harm, Krogsboll says, with overdiagnosis—such as finding a condition that would not have bothered a person had it gone undetected.
It's time to give the heave-ho this outdated habit, some say. Others argue that checking in with your doctor once a year is a good idea, especially as you age. Yet others recommend limited, targeted testing—screening with tests that show the most evidence of benefits and the least harm.
In the new analysis, tests done during the physicals differed from study to study. Typical were blood pressure checks, cholesterol, and blood sugar measurements, vision and hearing checkups. The follow-up periods ranged from about four to 22 years.
Those who saw a doctor regularly were more likely to be diagnosed with high cholesterol and high blood pressure, which is not surprising given the tests that are typically ordered.
Critics of the new review, published in The Cochrane Library, a well-regarded journal, point out that some of the studies were done as far back as the 1960s. Tests done then were different than the screening tests of today, and some were not as reliable.
True, says Krogsboll. But when Krogsboll compared old and new, ''in our results we did not see indications of newer trials showing better effects than older trials."
In the U.S., since the concept of the annual physical for healthy people was first proposed by the American Medical Association in 1922, the concept has evolved. For instance, the U.S. Preventive Services Task Force, a panel of health experts, evaluates the scientific evidence and makes recommendations about which individual tests should be done. Right now, it recommends, for instance, Pap tests in women ages 21 to 65 every three years. However, it does not recommend treadmill testing of the heart in those people without symptoms who are at low risk of heart disease.
Under the Affordable Care Act ("Obamacare"), certain preventive services are covered for those on new plans starting Sept. 23, 2010 or later. Among them, blood pressure screening and newborn hearing screening, as well as many others.
Despite the findings of the new review, not every doctor is ready to ditch the annual visit. Among them is Dr. Peter Galier, an internal medicine specialist at UCLA Medical Center, Santa Monica. He offered TakePart some perspective on the new review. "You are much more likely to pick up complaints when people come in once a year," he says. He strongly recommends the once-a-year visit for healthy adults beginning at age 40 for men and 45 for women.
He doesn't do the old-style physical—those ones that often included such seemingly random tests as tapping your knee with a mallet. Instead, he asks questions about any changes to a patient's medical history, listens to their heart and lungs, and does other screening tests as needed.
He learns a lot, he says, just from talking to and eyeballing a patient he's seen before. From that information, he can order tests that may tell him what is going on.
The debate about regular, routine checkups and their value is far from over, Krogsboll says. "We do suggest that future research is focused on the individual components commonly used in health checks, to see if some of them are beneficial or harmful.
"A large trial with 10 year follow-up will publish results on mortality next month, so that will inform us about the effects in a more modern setting," Krogsboll says. "However, the lead investigator on that trial has publicly stated that systematic health checks are a waste of money."