Jul 29, 2014 4:44 PM
July 29, 2014 -- If it's true that an apple a day keeps the doctor away, then it seems like seeing the doctor for an annual physical exam ought to play a major role in keeping healthy people healthy.
Yet most doctors now say it's time to rethink the notion of a yearly physical, a fixture in U.S. medicine since the 1940s.
Studies done over at least 30 years have shown that for healthy adults -- those who don't have a long-term illness or take daily prescription medications -- annual wellness checks don't lower the number of deaths. They also don't cut the rates of disease-related deaths, hospitalizations, or the cost of care.
"There's not a [ton] of evidence that going in annually, if you're healthy, prevents bad things from happening," says Thomas Miller, chief medical officer for the University of Utah's Hospitals and Clinics.
Instead, studies from multiple researchers found the annual exams can lead to the overdiagnosis of some conditions, overtreatment, and to invasive, costly tests.
That's exactly what happened to the 85-year-old father of Michael B. Rothberg, MD, MPH, a doctor at the Cleveland Clinic's Center for Value-Based Care Research, Medicine Institute. Rothberg wrote about the experience last month in the Journal of the American Medical Association.
"The $50,000 Physical" describes the string of medical treatments ordered for his father after an annual physical identified a suspected aortic aneurysm. He didn't have that, but a CT scan showed a lesion on his liver, which was suspected to be cancerous. A biopsy found Rothberg's father had a single benign tumor, but he nearly bled to death from the biopsy.
And yet, as Rothberg says, the practice of annual checkups persists.
That's in part because some doctor payments are tied to the practice, and also because patients have come to expect them each year. Data from a national 2010 survey found that 21% of medical visits were for preventive care. Having a general medical exam was the No. 2 reason people went to the doctor.
"It's ingrained into our culture," Miller says. "There's a belief among some that it makes sense, so there's always going to be a pool of folks who cherish the annual physical."
That's not to say you should ignore preventive care altogether. For instance, it's a wise idea to get your blood pressure and cholesterol checked. (Read on to find out how often.)
Your doctor can also help you work on healthy habits, like quitting smoking if you need to -- and that improves overall health, says Michael LeFevre, MD, MSPH. He's the vice chair of family and community medicine at the University of Missouri, and the chair of the U.S. Preventive Services Task Force (USPSTF).
So how, then, should health care consumers reconcile preventive services known to save lives against data that suggests an annual physical doesn't matter much?
"There are better ways to deliver preventive services then bringing people in once a year," LeFevre says.
"Better" means relying on the best and most current studies to figure out when testing makes the most sense. The task force, an independent panel of experts in prevention and evidence-based medicine, recommends age- or disease-specific screening tests instead of the once-a-year approach.
For example, doctors first began recommending women be screened annually for cervical cancer about 50 years ago. This promoted the need for an annual doctor's office visit. But now, women ages 21 to 65 need only have the tests every 3 years, LeFevre says.
"These are the things that the science tells us help people live longer and live better," he says. "What that requires is going to vary, based on individual circumstances, personal history, and age. I really do think it has to be individualized as opposed to saying everybody should get an annual physical."
Among the screening tests recommended by LeFevre and the USPSTF:
Blood Pressure: Every 2 years for adults with an ideal blood pressure below 120/80 points. Annually if your blood pressure is above 120/80.
Breast Cancer: Mammogram every 2 years for women ages 50 to 74. Women at higher risk should talk to their doctor about getting screened before age 50.
Cholesterol: For most people, testing every 5 years is recommended, starting at age 35 for men and age 45 for women. Men and women at risk for heart disease should start getting screened at age 20.
Colon Cancer: Screening for all adults between ages 50 and 75, usually every 10 years.
Young, sexually active adults should also be screened for sexually transmitted infections, LeFevre says. Talk to your doctor about what tests you may need and how often.
To make sure the testing gets done, Miller and LeFevre say they try to provide or schedule them when patients come in for other medical problems.
The rules are different for people with ongoing medical problems. Both doctors say they like to see those patients at least once a year.
The Affordable Care Act will make getting critical preventive tests easier, because it covers many of the tests that may not have been covered in the past.
Of course, you're more likely to get preventive services if you have a healthy relationship with a primary care doctor. And that's an argument for continuing to drop in for an annual physical, both Miller and LeFevre say.
"I think there is this human-touch piece ... this softer concept that meeting with your physician annually is developing trust and that the physician you are meeting with is someone to count on," Miller says.
He predicts, though, that it may not be long before any debate over the annual physical becomes moot. That's because technology is dramatically changing the way doctors and patients communicate.
Patients can look online to see their latest test results and use e-mail to ask questions -- some send cell phone camera photos -- about health concerns.
"This makes staying in touch with your patients outside the clinic much easier, so the dynamic of how we interact with patients is changing and will continue to change," Miller says. "I see a whole revolution out there."