Are Annual Physicals Really Necessary?

It is estimated that over 45 million Americans will get a routine physical examination this year. Certain aspects of the annual physical are now covered under preventative care without cost to the patient.

Interestingly, an article written by Dr. Ezekiel Emanuel, who is one of the experts that helped develop President Obama’s health care law feel that for most, an annual physical is “worthless”. He further contends that the cost of annual exams outweighs any potential benefits. This has sparked a great debate over whether the routine annual physical is really necessary.

There has been a greater push for evidence-based medicine. Taken from a 2012 review conducted by an international group of researchers, 14 randomized clinical trials that included over 182,000 people found that annual physical exams do not lower the overall cost of medical care, future appointment, disease-related deaths or even hospitalizations. Some such as Dr. Emanuel further contend that annual exams may lead to further screenings or tests with abnormal findings which have no specific meaning.

While some argue that annual physicals are geared primarily toward insurance companies and billing, many physicians feel that waiting until you are sick to establish with a physician is not the best practice. A one-on-one interaction with the physician in a non-stressed time that may allow a better physician-patient connection and thereby giving the physician a greater overall understanding of the patient. Perhaps a restructuring of the annual physical would be more beneficial? This point has been brought up by some physicians.

Based on the results of large longitudinal population study (Aerobic Longitudinal Study) of over 12,000 people, 99.8% of middle age adults do not manage the 7 primary risk factors in cardiovascular (and other) diseases:

1. Avoid smoking
2. 30 minutes of moderate physical activity daily
3. Control cholesterol levels
4. Manage blood pressure
5. Manage weight
6. Control blood sugar
7. Eat healthy foods

Only 0.2% of the study participants managed all 7 habits in their lifestyle! Fewer than 10% met 5 more of the habits described above. No cardiovascular related events occurred in any of the participants who met ideal levels of the 7 habits during the 20 year period of the study.

Taking this information into account, perhaps risk stratification (presence of medical comorbidities, disease risk factors and medications taken) should dictate frequency of check-ups while those who are asymptomatic may not need an “annual” physical but rather a periodic visit to review preventative and lifestyle factors such as those mentioned in the Aerobic Longitudinal Study.

References:

Emanuel, Ezekiel. Skip Your Annual Physical. New York Times op-ed. January 9, 2015