NYT: Should we get rid of annual physicals?

Soaring health costs may prompt U.S. to rethink annual ritual

Annual, head-to-toe physicals for healthy Americans may become a thing of the past as primary care physicians (PCPs) and specialists work to address soaring health costs, physician Elizabeth Rosenthal argues in the New York Times.

U.S. physicians persevere, despite lack of evidence
Rosenthal contends that annual physical exams for asymptomatic individuals have little benefit, lead to unneeded procedures, and have been abandoned by other Western nations. For example, a Canadian government task force in 1979 officially recommended against annual physicals, citing a lack of evidence that the exams help with care. 

However, U.S. hospitals and health providers have continued the practice; a relatively new model of "executive physicals," which include a battery of screening tests, also are booming. 

The costs of physicals add up, Rosenthal concludes. According to UPMC assistant professor Ateev Mehrotra, unnecessary blood tests performed during physical exams cost $325 million per year.

According to Rosenthal, the nation's attachment to annual physicals stems from physicians' profit motives, direct advertising of protects and treatments to patients, malpractice concerns, and physicians' habits.

"There's a lot of inertia and unwillingness to let things go—it's hard for doctors and patients," says Alan Brett, an internist and professor at the University of South Carolina.

America may rethink annual exam ritual
However, the physical's future may be in doubt, Rosenthal argues, because primary care physicians and specialist groups are better trying to control health costs by curbing unnecessary tests and procedures.

For example, the American Board of Internal Medicine Foundation, Consumer Reports, and myriad physician organizations recently identified 45 unnecessary procedures through the Choosing Wisely campaign

According to Rosenthal, these efforts may prompt the medical community to abandon the annual exam practice.

Brett notes that only a few screening tests are recommended for healthy individuals, and many of those tests do not require a doctor's visit. "If you follow [official] recommendations you hardly do anything to patients," he says. Although he still performs head-to-toe exams on new patients, he avoids routine blood work and instead focuses on lifestyle counseling (Rosenthal, Times, 6/2).


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