Are Annual Physicals Necessary?
I thought annual physicals were a relic of the past, but I’ve read that this continues to be a controversial medical subject. What’s the word? Should we have annual physicals or not?
Andrew Weil, M.D. | June 6, 2016
The question of whether or not regular (although not necessarily annual) physical exams are worthwhile has triggered recent medical debate. The latest opinion was advanced in the January 5, 2016 issue of the Annals of Internal Medicine by David Himmelstein, M.D., a professor at the City University of New York School of Public Health at Hunter College. He noted that the case against regular physical exams is based on a 2012 review of 14 studies – some dating back to the 1960s and 1970s – which concluded that the check-ups did not reduce illness and death. Dr. Himmelstein made the point that the studies included in the review weren’t aimed at evaluating the benefits of the check-ups themselves but at the value of adding certain screening tests for people who already were seeing their physicians on a regular basis.
He also noted that another review of 33 more recent studies showed that routine exams did benefit patients, particularly those in high-risk groups.
Arguing against annual physicals in the New England Journal of Medicine, Drs. Ateev Mehrotra, associate professor of Health Care Policy and Medicine at Harvard Medical School and Allan Prochazka, professor of internal medicine at the University of Colorado School of Medicine, cited analysis of studies suggesting that the exams don’t reduce illness or death but added that, “They may be associated with reduced patient worry and increased use of preventive care.” The two doctors also maintained that the annual physical has the potential to be harmful, because some routine tests that lack specificity may yield false positive results in patients who have no symptoms. They made the point that physicians who favor annual physicals often do so in order to establish or renew relationships with their patients, although the question of whether these visits actually accomplish that purpose hasn’t been well studied.
My view is that if you’re healthy, an annual physical isn’t necessary. Instead, a routine checkup every five years should be sufficient. However, if you’ve never had a complete physical as an adult, I recommend scheduling one.
More frequent checkups – every 2 years – are a good idea for those with a family history of heart disease, cancer or another serious health problem. If you have a strong family history of a serious disease, I do recommend an annual physical. Also, consider seeing your physician every 2 years if you have a chronic illness or poor lifestyle habits such as smoking, an unhealthy diet or lack of exercise that increase disease risks. And be sure to see a doctor promptly if you develop any symptoms that could signal a change in your health status.
Finally, an annual physical can be reassuring if you tend to worry a lot about your health.
Andrew Weil, M.D.
Sources:
David U. Himmelstein and Russel S. Phillips, “Should We Abandon Routine Visits? There is Little Evidence for or against.” Annals of Internal Medicine, January 5, 2016, doi:10.7326/M15-2097
Ateev Mehrotr and Allan Prochazka, “Improving Value in Medicine, Against the Annual Physical.” New England Journal of Medicine, October 15, 2015, DOI: 10.1056/NEJMp1507485
L.T. Krogsbøll et al, “General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis.” BMJ, November 20, 2012, doi: http://dx.doi.org/10.1136/bmj.e7191
