Do We All Need an Annual Physical Exam??

You haven’t seen your doctor in two years and your spouse is on your case to get your overdue annual physical examination.  You reply that you feel fine, have no symptoms, and see no need to be examined.  What is the right answer? Is there evidence that an annual physical examination in the absence of concerns or symptoms is in your interest?  The answer is surprisingly complicated.

In the early 20^th century the concept of an annual physical examination began to take hold in the United States, and by post World War II it had become gospel. However, in recent years, concerns about the cost, efficacy and even risks of frequent physician encounters have been raised. Abnormal findings or tests in asymptomatic adults may be “false positives”, and may lead to a cascade of further testing and risk exposure; this is the basis of the controversy regarding issues such as prostate cancer screening in men and mammogram screening in women under the age of 50.

Over a dozen studies have looked at this question and when pooled, indicate that general health checks in the community setting do not reduce overall mortality, hospital admissions or absences from work.

We need to be very careful in interpreting these studies. The data refers to patients without chronic underlying conditions, so therefore do not apply to patients with hypertension, high cholesterol, obesity, diabetes, etc. 

They focus on patients who have no symptoms and no specific concerns or worries they wish to address, but rather on totally asymptomatic adults. In addition, there are a number of medical screenings and interventions which are clearly beneficial depending on patient age, sex and risk factor analysis which can and should be delivered even in the absence of a traditional examination which includes minimally productive steps such as saying “ahh”, turning your head and coughing, and having your reflexes checked.  Important examples (but not an all-inclusive list) of these important medical interventions include flu vaccination, colon/breast/cervical cancer screening and blood pressure checks.

Another argument in favor of the annual examination is that it supports and facilitates an ongoing relationship with a primary care provider so that you can get annual health advice, reminders of needed screenings and interventions, and a comfort level that you have someone to contact should any health concerns develop. This benefit of regular physician contact is almost impossible to study or quantify.

So, the minimal components of your relationship with the health system should include the identification of a trusted primary care provider, a conversation with him/her about his/her philosophy regarding period non-symptom related visits, and a knowledge of the recommended health services which have been shown to have benefit (for a good overview check out www.uspreventiveservicestaskforce.org/recommendations.htm).