Do I Need an Annual Physical?

Let’s see what the New York Times has to say.

Last Friday, this question appeared in its “Ask Well” column.

The author, Karen Weintraub, acknowledged that annual physicals “don’t help people avoid death, hospitalizations, worry or future appointments.” She also mentioned that yearly checkups can generate unnecessary procedures, complications, and needless expense.

She then quoted two doctors. One, Pieter Cohen, MD, of Harvard, said if you don’t get a complete physical, “you’re only going to the doctor when you’re sick, and that makes absolutely no sense.” Really? To whom?

The other doctor, David Himmelstein, MD, a professor of public health at the City University of New York, said, “I think I take better care of people if I know who they are and have some sense of connection to them.” He thinks he does?

In the era of evidence-based medicine, justifying an annual physical examination based on two completely unfounded quotes is puzzling.

The article concluded with some thoughts about how to improve the annual physical such as “making more time for genuine interaction between doctor and patient.”

How well does a doctor get to know a patient he sees once a year? Even if an annual physical took an hour to do, would that be enough time to get to know someone well?

Show me the data to support the idea that getting to know patients better and having genuine interactions with them leads to better outcomes.

About 45 million Americans get annual physicals every year. At a conservative estimate of $200 per exam, that’s $9 billion not counting the inevitable lab tests and x-rays that are ordered.

What makes this more interesting is that 4 months ago in the very same New York Times, Dr. Ezekiel J. Emanuel wrote an opinion piece called “Skip Your Annual Physical.” He described several studies showing that annual physicals do not lower overall or disease-specific mortality rates.

He said, “This lack of evidence is the main reason the United States Preventive Services Task Force—an independent group of experts making evidence-based recommendations about the use of preventive services—does not have a recommendation on routine annual health checkups. The Canadian guidelines have recommended against these exams since 1979.”

He also debunked the theory that routine physical examinations prevent or discover treatable diseases and speculated about how much money is wasted.

Dr. Emanuel made a New Year’s resolution to not get an annual physical and invited his readers to join him.

Even though “it makes no sense,” I’m siding with Dr. Emanuel on this. What do you think?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.