The necessity of yearly physicals

DEARDOCTOR>> I’m a 45-year-old man without any major medical problems. Is it worth it for me to get yearly physicals with my primary care doctor? DEARREADER>> That’s a difficult question to answer. I have generally encouraged annual physical exams for most of my patients in their 40s and beyond. I schedule more time for this type of examination so that I can collect a history of a patient’s lifestyle, conduct a review of their symptoms, and determine whether they have had the recommended colonoscopies, mammograms and vaccinations. With both the history and the physical examination, I learn aspects of the patient’s health that were often not known to me prior.

From my subjective vantage point as a primary care doctor, I find value in these visits. But objectively, the benefit of physical exams is less clear.

Take a 1986 study comparing death rates of more than 5,000men between the ages of 35 and 54 who’d had six health checkups to more than 5,000 men who’d had one checkup. Over a 16-year period, researchers found a decrease in death rates from colon cancer and hypertension among those men who had more checkups, but they found no decrease in death rates from other causes.

A 2007 article in the Annals of InternalMedicine reviewed 33 studies assessing the efficacy of health checkups. Researchers tried to determine if physicals caused benefit, caused harm, or had no impact on a patient’s health. The largest benefit seen from physicals was through an increase in colon cancer screening. A more intermediate benefit was seen through the administration of Pap smears and cholesterol checks. The physicals also showed a benefit in decreasing worry among patients.

However, overall, the results showed no benefit seen in regard to death rates. The biggest problemwith this assessment is that the different studies included so many variables, reaching conclusions proved difficult.

A 2012 BritishMedical Journal study analyzed a combination of 14 older studies assessing the benefits of health checkups. The study did not find any difference in death rates between those who had physicals and those who didn’t. However, in one case, what the authors defined as the group receiving health checkups amounted to one physical over a 22-year period. In fact, participants in eight of the 14 studies evaluated had only one physical exam done for the time frame of their studies. The studies that showed more health checkups actually had better outcomes. The authors also tried to show if having physicals actually caused harm, but could not do so.

Obviously, the question needs to be studied further — and electronic medical records give us the ability to do this. The critics of routine health checkups say they lead to unnecessary testing, possibly harmful tests and cost about $10 billion per year.

Yet I find that the most important aspect of the health checkup is the time to sit with patients — to talk to them about their level of exercise, their diet, their drug habits and their level of sleep; to review whether they’re having shortness of breath, chest pains, or problems with urination or bowel movements — and many times to learn about the stressors in their lives. This time is an important aspect to the doctor-patient relationship and is difficult to quantify.