A yearly check-in with a doctor seems undeniably prudent. He or she can listen to your heart, check your blood pressure and help you nip any looming health issues in the bud.
But while annual well visits are a familiar part of the health care system, a growing pile of evidence finds that for healthy people without any symptoms, these yearly physician exams are a waste of time and money—and in some cases may do more harm than good.
One large-scale review, published in 2012, found that annual physical exams do nothing to improve a person’s disease and mortality risks. Another recent study found a little evidence that annual physicals could reassure some people of their good health, and therefore reduce worry. But it did not find that these exams save lives or prevent disease.
As a result of these lackluster findings, some experts have called for an end to annual physicals.
“If you’re healthy, there’s every reason to believe these visits make no difference,” says Dr. Ezekiel Emanuel, a professor of health care management and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine. “Doing a bunch of unnecessary tests and taking up valuable time for people who are well—that’s not useful.”
But it is expensive.
Roughly one in five adults gets an annual physical—also known as a preventive health examination, or PHE—and all those check-ups cost insurers and patients more than $5 billion annually, according to a 2007 study from Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School. (That figure doesn’t take into account the billions in lost productivity that result from healthy adults taking time off from work to visit their doctors.)
Annual physicals are a big drag on physicians’ office hours and cut into their ability to spend time with sick patients in need, Mehrotra wrote in 2015 in the New England Journal of Medicine.
“In our [annual physical exam] trials, we have not seen any improvements in what we care about, which is longer and healthier lives,” Mehrotra says. “While older adults”—those 65 and above—“may benefit, younger people don’t need this exam every year.”
Even some doctors who feel less certain that an annual physical is wasteful agree with the research findings to date. “The evidence does not support that an annual physical exam is necessary,” says Dr. Ted Epperly, a physician and president of Family Medicine Residency of Idaho. “Having said that, my sense is that [the annual physical’s] place in American medicine is still felt to be valuable by both physicians and patients.”
Epperly says annual physicals help doctors and patients form closer relationships, which can improve the quality of care. “I think having a relationship with my patients builds trust and allows for better counseling around preventive behaviors and lifestyle factors like diet and exercise,” he says. Also, when people feel they have a good relationship with their doctor, they may be more willing to make appointments when they notice new symptoms, or to request advice when debating a health-related decision, he says.
Mehrotra says he agrees strengthening the doctor-patient relationship could provide some benefits. “But if the goal is to improve that relationship, we should get rid of the head-to-toe exam elements and the tests that get ordered—like annual bloodwork—and spend more time discussing patient lifestyle and concerns.”
Even those who believe the routine physical should stay say changes are needed—and that healthy people probably don’t need to see a doctor every single year.
“It is very well known that having a strong and trusting doctor-patient relationship is essential to getting best outcomes in health care,” says Dr. Allan Goroll, a professor of medicine at Harvard Medical School. “Unfortunately, it’s becoming harder and harder to have this relationship because of the current system’s focus on procedures and generous payments for procedures, rather than on taking time to get to know someone and establishing a relationship.”
Goroll says annual physicals shouldn’t be so much an exam as an “annual review of health, both going over concerns and coming up with a plan for prevention.” He says that payers—or insurance companies—are starting to recognize the benefits of this sort of visit, and so are reimbursing doctors better for these sorts of wellness consultations, rather than for ordering tests and analyses.
But he says he agrees that much of the current system—physical exams that are “rushed, impersonal, and bureaucratic” affairs that are mostly about ordering tests, as Mehrotra puts it—are not doing patients much good. He also says younger adults (those under 40) without health issues don’t need to see a doctor for an exam every year. As long as you’re going often enough to establish a trusting relationship with your doctor—every few years, or less if you grew up with your doctor—that’s probably good enough.
Even for older adults, many experts say that if you’re following the guidelines laid out by the U.S. Preventive Services Task Force—guidelines concerning the right age and frequency for cholesterol checks, blood lipid tests, mammograms and other screening services—you don’t need to worry about annual physicals. (To see which tests you need, plug your age and gender into the government’s MyHealthFinder tool.)
But if you have health problems, don’t skip your annual. “All of this discussion about annual physicals is not for people with health problems,” Emanuel says. If you’re sick or symptomatic, or if you have a family history of disease, then “yes, you should be seeing a doctor,” he says.
Mind & Body – Health.com