During my years in practice, I actively encouraged patients to have an annual check up. I thought it was a good practice for patients to see a doctor at least once a year for “preventive maintenance.” I’ve even written a couple of blogs on the value of annual physicals; one was titled “Executive Physicals: Are they worth the money?” and the other, “Annual Physicals: Are they really necessary?” These are thought-provoking articles on a subject about which there is much disagreement.
My advocacy of the annual physical is based on my belief that it is a prime opportunity for the physician to learn everything possible about the physical condition of his patient. It’s also, the rare opportunity when a patient can submit himself to the careful scrutiny of his physician to learn if his health is good or if there are problems. Done thoroughly and properly, the annual exam can be very informative if not life-saving.
Called by various names (“general medical exam, periodic health evaluation, checkup, complete physical, wellness visit”) the adult annual exam has been questioned by people for decades. It’s value is a topic of disagreement among physicians and others. Employers and spouses, however, are probably the most influential forces in encouraging the reluctant to get a check up. Both have a vested interest in the good health and longevity of their employee or loved one.
To bolster my position in favor of annual physicals, I cite an article in the June 8, 2021, issue of JAMA. This article extracted information from 19 “randomized trials and observational studies” to see what benefits came from the time and money spent on annual physicals.
Right away, the authors took a negative position regarding complete physicals. They state “General health checks were…..not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence.” One might conclude that this statement would lessen a physician’s commitment to annual physicals, but that is not the case. They did report
some good news.
The studies cited did show that general health checks have positive benefits that are associated with positive outcomes. Because of annual check ups….
There is increased detection of chronic diseases: eg. depression, hypertension
There is moderate improvement in controlling risk factors: eg. cholesterol, BP
There is increased use of clinical preventive services: eg. cervical and colorectal
cancer screenings
There is improvement in patient-reported outcomes: eg. quality of life, self-rated
health
There is “sometimes” modest improvements in health behaviors: eg. diet, physical
activity
The benefits identified in the 19 studies referenced could, and probably do, translate into decreased mortality and less cardiovascular disease. Everyone is going to die, we just don’t know when or from what. We do know, however, that being aware of chronic diseases and risk factors, and treating them aggressively, has been shown to have positive results.
Despite the numerous benefits of having an annual check up, the United States Preventive Services Task Force (USPSTF) still recommends against them; but since when did they have any common sense or understanding of public sentiment. It is a bit discouraging to read that mortality and cardiovascular disease outcomes are not improved by the annual exam, but as I stated above, finding a risk factor and treating it, may actually lead to better statistics in these areas. Quality of life is a big issue with people, so if a physical improves that, I think that’s a definite plus.
Who knows if diagnosing a chronic disease early is going to lengthen a person’s life. Opinions differ widely. No one knows how long they’re going to live, so our interventions may be helping people live longer and we not realize it. My feeling is, what’s the harm of doing a physical? There is only up side. Something totally unexpected may be found. Yes, there is a cost. You may spend $1000 and find nothing, but that’s money well spent. But if you find something(s), you now can begin close surveillance of that problem and prevent a bad outcome, or lessen its severity, down the road.
The annual check up gets an undeserved bad rap. It has more value, I think, than most people acknowledge. I think having an annual check up is a worthwhile idea that should be employed far more often than it is.
Reference: Liss DT, Uchida T, et al. General Health Checks in Adult Primary Care: A Review JAMA 2021 June 8;325(7):2294-2304.
