Should You Get an Annual Physical Exam?
Annual physical exams date back about a century in American medicine, but many health authorities now believe “routine annual checkups for healthy adults should be abandoned.” However, most people still expect a comprehensive annual physical exam, and extensive routine blood testing, too. “Given the gap between patients’ enthusiasm for and [the new] guidelines’ skepticism about annual head-to-toe examinations, what are physicians to do?” As I discuss in my video, Is It Worth Getting an Annual Physical Exam?, first, we must educate patients about preventive practices with proven and unproven benefits. For example, cholesterol is the only routine blood test recommended by the U.S. Preventive Services Task Force (USPSTF), the official preventive medicine guidelines-setting body.
Why do so many physicians continue to perform annual exams and order some of the very tests that are “ineffectual or even harmful”? Otherwise, the patient might leave the doctor’s office unsatisfied with the visit. “Evidence suggests that the more thorough physicians are (that is, the more physical and laboratory examinations they perform), the better patients feel about their health and physicians.” So, examinations and testing are like “placebo clinical manoeuvers…But rather than performing unnecessary (and sometimes contraindicated) physical exams and laboratory tests during an annual visit, physicians should spend some of the time saved by telling their patients why they are not examining their abdomens, hearts, and lungs.”
Educating about the dangers of overdiagnosis is critical. Certainly, wrote a doctor from the famed Cleveland Clinic, there is “a small possibility that our examination might detect some silent, potentially deadly cancer, or aneurysm. Unfortunately for our patients, these serendipitous, life-saving events are much less common than the false-positive findings that lead to invasive and potentially life-threatening tests.”
He shared a story about his father. During a checkup, his dad’s physician thought he felt an aortic aneurism, so he ordered an abdominal ultrasound. His aorta was fine, but something looked suspicious on his pancreas, so a CT scan was ordered. Thankfully, his pancreas looked fine, but was that cancer on his liver? He went to a specialist, who did a biopsy. The good news? No cancer. The bad news? It was a benign mass of blood vessels, so he almost bled to death when they stuck a needle in it to biopsy. He required ten units of blood (which is about all we have). This resulted in pain, which resulted in morphine, which resulted in urinary retention, which resulted in a catheter, yet, thankfully, no infection — just a $50,000 bill.
There wasn’t any malpractice. Every step logically led to the next. “The only way to have prevented this [life-threatening] outcome would have been to dispense with the initial physical examination.”
Indeed, “too many patients bear the costs and harms of unneeded tests and procedures,” but overdiagnosis is big business. Just think about the “downstream revenue” for the hospital and all the specialists, tests, and exams.
This article first appeared on NutritionFacts.org.