The Case Against an Annual Physical
Feb 28, 2024
For some of us, the yearly exams
might not be doing much to boost long-term health
Is your annual physical a waste of time?
A
growing number of physicians say the value of a yearly physical depends in part
on your age and health history, and that some young, healthy patients can
afford to skip it. Some studies have suggested that the annual visits aren’t
doing much to improve our long-term health, and a growing shortage of
primary-care doctors can drag out appointment wait times.
Plenty of doctors still recommend
an annual checkup, but more are changing what they do in that appointment, focusing on habits such as sleep, exercise and diet with
less poking and prodding in a physical exam.
An increased focus on lifestyle
reflects the recognition that standard once-a-year physicals haven’t managed to
stop the rise
in chronic diseases such as obesity and
Type 2 diabetes, which now affect roughly 42% and 10% of American adults
respectively, according to Centers for Disease Control and Prevention data.
“There are parts of what we do in a
yearly exam that are valuable,” says Dr. Yul Ejnes, a primary-care doctor
who sits on the board of the American Board of Internal Medicine. “It’s just
that the delivery method that’s been used for decades may not be as effective
as we think it is.”
Other than managing blood
pressure, assessing body-mass
index, and screening for cervical cancer in women, regular physical exams
in asymptomatic patients haven’t been shown to improve health, says the latest
recommendation from the Society of General Internal Medicine, a professional
group.
A review in the
medical journal JAMA found that overall, checkups weren’t linked to
lower mortality rates or improvements in cardiovascular problems, although they
were linked to better catching and treating of chronic disease.
Another analysis found that annual physical exams were associated
with lower
mortality risk among healthy adults compared with those who didn’t
attend annual physicals.
If
you’re at high risk of chronic disease, worried about your health or rarely see
your doctor, you’re likely to benefit from annual checkups, according to the
SGIM. Most doctors still recommend patients come in for a yearly visit—which
often includes a thorough physical exam—especially as they move into midlife
and beyond.
Doctors
recommend that you follow guidelines
for preventive screenings regardless of whether you get annual
physical exams. Even young, healthy patients aren’t immune to health risks,
such as rising
rates of some cancers.
Rethinking the yearly visit
In
2022, roughly 78% of adults reported seeing the doctor in the past year for a
wellness visit, according to the CDC, including 68% of adults under 45.
Traditionally,
the annual physical involves a head-to-toe assessment that often includes
listening to a patient’s lungs and heart; recording their weight, height and
blood pressure; and checking reflexes and blood tests.
One Medical, a membership-based primary-care practice with offices
around the country, redesigned its annual checkup in 2020 to emphasize
patients’ personal health goals and lifestyle counseling rather than strictly a
physical assessment. It starts with patients filling out a questionnaire in
advance that covers topics such as sleep and exercise habits, alongside family
history of illness.
Generally,
that means patients can keep their clothes on during the “Live Well” visit,
says Dr. Hemalee Patel, who heads a team focused on chronic-disease management
at One Medical. The physical exam is pared down compared to a traditional
checkup—Patel says she doesn’t always check reflexes or look in a patient’s
ears, for example. That allows more time for talking through topics such as
mental health and behavioral changes, she says.
“I
could take a slew of vital signs and check reflexes and listen to your heart
and you could leave that exam without any of the questions that you’re hoping
to get answered,” she says.
Regardless
of how young or healthy they are, patients are still recommended to come in
annually, she says. Roughly a quarter of the company’s members came in for the
annual visit in the past year.
Previsit screening
Other
approaches lean on technology and previsit screening.
BellSant,
a health technology company, is hoping to sell doctors on a new preventive care
approach.
Rather than patients scheduling an annual physical, they would fill
out health assessments on an app and get a blood test. Their doctors would use
that information, plus data from users’ wearable devices, to give priority to
patients with more urgent health needs.
For
some patients, virtual care might suffice, says Dr. Lisa Lehmann, a physician
on BellSant’s advisory board of about 20 health experts.
“For
an asymptomatic patient, it’s not that they’re never going to see a physician
in person, they just might not be prioritized,” says Lehmann, who is also an
associate professor of medicine at Harvard Medical School. “When they do see a
physician in person, that person is going to be armed with a lot more
information about the patient.”
Supporters of the traditional approach say conducting a consistent,
by-the-book physical exam with every patient allows them to catch issues they
might not otherwise, establishes a health baseline and reduces the chance of
error. A thorough examination also helps put many patients at ease, says Dr.
Eve M. Glazier, a general internist and president of the multispecialty
provider group UCLA Health Faculty Practice Group.
The
traditional annual physical becomes more useful as patients age and are more
likely to develop chronic conditions and take multiple medications, says Dr.
Mirza Rahman, physician and president of the American College of Preventive
Medicine.
Not enough doctors
Spending
less time on physicals for young, healthy people could ease a strain on primary-care
doctors, some say. The Association of American Medical Colleges estimates there
will be as many as 48,000 too few primary-care physicians practicing in the
U.S. by 2034.
In
some ways, patients are already reinventing the annual physical themselves.
More are visiting retail
clinics and urgent-care
centers that rely more heavily on nurse practitioners and physician
assistants to provide primary care.
Katherine
Morgan, a 30-year-old bookstore owner in Portland, Ore., says she called
several primary-care clinics in early December before she finally found one
with an opening in March. In January, she decided to visit a local urgent care,
which ultimately diagnosed her with Type 2 diabetes.
“This
shouldn’t be as frustrating as it is, just try to get an appointment within the
same year,” says Morgan.
Source: Wall Street Journal