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Doctors Debate Worth of the Annual Physical Exam

Some believe health care’s time-honored tradition is unnecessary

With a growing amount of evidence showing that yearly physicals do not reduce overall risk of disease or death, many physicians want to abandon the practice. Others believe the yearly checkups help build doctor-patient relationships and help both parties be better prepared for illness.

An editorial in the New England Journal of Medicine provides both perspectives from Harvard professors.

HealthDay noted that the original idea behind the annual physical examination held that these visits provide doctors with an opportunity to practice preventive medicine, said Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School in Boston. Doctors would detect problems such as high blood pressure, increased cholesterol, or high blood sugar and help their patients take steps to prevent these early warning signs from developing into chronic illnesses such as diabetes or heart disease, he said.

But this idea has not withstood scientific review. "In good studies, in both randomized trials and in observational studies, we have not found any of those benefits," said Mehrotra, coauthor of the editorial questioning the value of traditional physical exams.

Overall, these annual visits cost more than $10 billion a year, Mehrotra said. And yearly physicals can be harmful, he added, noting that tests such as urinalysis in patients without symptoms often yield false-positive results, causing patients needless anguish.

However, by regularly seeing their patients, doctors can learn about many aspects of a person's life — work stresses, family issues, financial pressures — that can affect their health and well-being, said Dr. Allan Goroll, a professor of medicine at Harvard. That "can't be done in five minutes, and it can't be done by a questionnaire. It's done by looking a patient in the eye and giving them the feeling they aren't being rushed," said Goroll, who wrote the editorial defending the annual exam.

Both Mehrotra and Goroll said there's a need to reform the annual physical.

Mehrotra believes regular checkups should be reserved for people who haven't seen their physician in two or three years. "I do acknowledge for people who haven't seen a primary care doctor for several years, going in to maintain that relationship does make sense," he said. Doctors should use electronic health records to maintain preventive health care for everyone else, Mehrotra said.

Goroll argues that the annual physical should be continued for everyone, but in a team-based approach where nurses, medical assistants, and care coordinators handle most of the routine preventive-care chores. That will give doctors the time to have in-depth conversations with patients, which could help guide their future health care, Goroll said.

Source: HealthDay, October 15, 2015.

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