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July 9, 2019

Do you actually need an annual checkup?

Daily Briefing

    Annual checkups were originally designed to detect early signs of disease, but recent research has clinicians debating whether annual medical exams are worth it, Rita Rubin, a senior writer at JAMA writes in a medical news and perspectives article.

    The purpose of the checkup

    The American Medical Association (AMA) first endorsed the concept of the checkup almost a century ago, Rubin notes. The purpose of these examinations, the chair of AMA's Committee on Health and Public Instruction wrote in JAMA in 1922, was "to detect the early evidence of disorder before discomfort, inconvenience, interference with work, or anxiety [had] driven [apparently healthy people] to seek medical advice for the treatment of established disease."

    Research raises questions about the value of a checkup

    But while the checkup might've made sense in 1922, "physicians and other interested parties have debated the value of checkups for decades," Rubin writes.

    And there's research to back up some of the checkup naysayers, Rubin writes. According to Rubin, randomized trials have found that patients who received periodic health checkups were no less likely to die from any cause or from cardiovascular disease or cancer than those who did not get annual checkups.

    With these findings in mind, Rubin notes that the Society of General Internal Medicine has said that "'the evidence base is definitely insufficient to support routine use of annual general health checks for asymptomatic adults without a specific concern, chronic condition, or evidence-based prevention strategy.'"

    Similarly, a recent Cochrane Review of 17 randomized trials found "high-certainty evidence" that checkups are "unlikely to benefit patients and might lead to unnecessary tests and treatments," Rubin writes.

    Checkup proponents say research only examines one facet of checkups

    Despite the evidence calling the value of checkups into question, plenty of physicians still support them. Checkup advocates say the visits today are more than a "disease screening or risk factor," as they were defined in the Cochrane Review, according to Rubin.

    Allan Goroll, a professor of medicine at Harvard Medical School and a primary care general internist at Massachusetts General Hospital and supporter of the checkup, explained that the evidence in the studies that have been critical of checkups "strictly looks at the measurable." In turn, checkup doubters "forget that there are other things people get out of an annual visit, and they're not looking at those things," Goroll said.

    The purpose of annual checkups, according to Goroll, is "the development and sustaining of a trusting healing relationship" between the patient and the clinician. "A problem with our society is that relationships have become scarcer and undervalued," he said.

    To make his point, Goroll points to his experience with a patient who had severe coronary artery disease and was only able to quit smoking because of the work Goroll and the patient did together.

    Instead of moving away from checkups, physicians should look to reframe them so that they are designed to develop and maintain a plan for patient health for the long term, according to Goroll. The visits don't even have to be annual, he said, and can be adapted to patients' needs.

    "There is no question that the stripped-down, check-the-boxes excuse for an annual visit has no value, and shame on us for offering that to patients," Goroll said. "What we need are high-value visits that are personal, that focus on building trusting relationships, that focus on key concerns of patients" (Rubin, JAMA, 6/19).

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