It may be time to ditch the annual physical.
Evidence for getting rid of the yearly check-up has been building for years, and two doctors published an opinion piece supporting this idea in the New England Journal of Medicine last week.
Drs. Ateev Mehrotra, of Harvard Medical School, and Allan Prochazka, of the University of Colorado Denver, note that a task force of Canadian doctors was recommending against an annual physical for healthy adults as far back as the 1970s, and the US Society of General Internal Medicine joined them in 2013.
Yet one-third of American adults still get an annual physical, Mehrotra and Prochazka report. And it costs the country about $US10 billion per year.
The US Department of Health and Human Services recommends adults visit the doctor “from time to time.” The department then has visit frequency breakdowns for each age group and gender, specifying when people should go to the doctor to checkup on everything from diabetes and blood pressure to their mental health. Healthy adults, the recommendations say, should visit the doctor just once every two years.
An accompanying opinion piece published in NEJM by another Harvard Medical School physician offers a compelling counterpoint for keeping the annual physical. His main reasoning is that patients and doctors like it too much to quit — something Mehrotra and Prochazka agree with, but say should change.
Dr. Allan H. Goroll argues that the yearly checkup builds valuable trust between physicians and patients, though the research that has shown this has only been observational. The physical examination itself as doctors check vital signs, he argues, can have a “powerful effect of the ‘laying on of hands,’ appreciated by healers over the centuries.”
Goroll suggests doctors improve the annual physical instead of eliminating it. If nurse practitioners or physician’s assistants could collect the routine vital signs and health information, Goroll writes, then doctors could use their time more effectively and only go over problems and health care goals with patients.
But even he thinks the annual physical doesn’t necessarily need to be annual for healthy adults.
Mehrotra and Prochazka suggest insurers should stop covering annual physicals and make the costly, unnecessary, and time-consuming practice a thing of the past.
“The annual physical is not evidence-based: research has demonstrated both its minimal benefit and potential harms,” they write. “We believe it’s time to act on this evidence and stop wasting precious primary care time by having a third of the adult population come in for such visits.”
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