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April 8, 2015

Why 44 million Americans continue to get annual physicals

Daily Briefing

    Millions of Americans believe annual physicals are an important part of staying healthy, but many experts say the yearly trip to the doctor's office can actually do more harm than good, Jenny Gold writes for Kaiser Health News.

    According to a survey from the Kaiser Family Foundation, 92% of U.S. residents say it is important to get an annual physical, and 62% report actually getting the exam. Overall, a 2007 study in JAMA Internal Medicine suggests that about 44 million Americans get the exam every year.

    What are the actual medical benefits?

    Some experts say the perception that an annual physical promotes health is misleading. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School, says, "I would argue that we should move forward with the elimination of the annual physical."

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    Mehrotra acknowledges that his position is not always popular. "When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm attacking moms and apple pie," he says, explaining, "It seems so intuitive and straightforward, and [it's] something that's been part of medicine for such a long time."

    But he says randomized clinical trials have not found annual physicals to promote better health. Yearly visits are also expensive. "We estimate that [the total cost of yearly exams is] about $10 billion a year, which is more than how much we spend as a society on breast cancer care," Mehrotra says.

    Physicals also can cause unnecessary stress for patients and lead to excess testing. "I generally don't like to frighten people and I don't like to give them diseases they don't have," says Michael Rothberg, a primary care physician and researcher at Cleveland Clinic. Doctors "start to look for things and order tests because that's what doctors do," he observers.

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    When patients insist on scheduling a yearly exam, Rothberg says he focuses on topics like diet and exercise, as well as any age-appropriate vaccinations or screening procedures.

    Experts: For some patients, annual exams still make sense

    The Society for General Internal Medicine lists annual physicals for healthy adults as something doctors should avoid. However, David Fleming, president of the American College of Physicians, says yearly exams are still appropriate for certain patients.

    For instance, doctors should "do a full assessment of everything" for elderly patients, focusing on issues like whether they are at risk of falling or have received a flu shot. "This is a population where it's definitely indicated," Fleming says.

    More broadly, some doctors still see medical value in the annual exam for healthy adults. Mark Caruso, a primary care physician at Baptist Health Primary Care, says it is an important component in building doctor-patient relationships and can help doctors intervene early for serious diseases. Caruso suggests, "What if when [a patient] had his shirt off, [he] said, 'Oh yeah, I forgot to mention this spot on my chest,' and it ended up being a melanoma we discovered early?" (Gold, Kaiser Health News, 4/6).

    The takeaway: Many Americans think annual physicals are an important part of managing their health, but experts say there is little evidence to suggest that healthy adults should be examined yearly.

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    1. Current ArticleWhy 44 million Americans continue to get annual physicals

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