Annual Checkups: A Thing of the Past?

But many doctors and patients still believe in them, survey finds

MONDAY, June 27, 2005 (HealthDayNews) -- You've no doubt been told by your doctor that annual physical exams are important, even though current treatment guidelines say they are unnecessary for people without specific symptoms.

However, many primary-care doctors and the public have not accepted these guidelines, according to a new study in the June 27 issue of the Archives of Internal Medicine.

Guidelines developed in the last 20 years do not recommend a routine annual physical examination and testing for adults without symptoms of illness. These guidelines suggest a more selective screening process, based on a patient's personal and family history and overall disease risk.

Despite these guidelines, many Americans expect an annual physical exam with extensive testing.

"We did a survey of physicians in three areas in the country (Boston, Denver and San Diego) asking about their attitudes about the annual physical examination," said lead author Dr. Allan V. Prochazka, a professor of medicine at the University of Colorado Health Sciences Center School of Medicine. "We found that physicians, in general, were in favor of the concept of an annual physical exam."

The physicians believe that the exam was valuable for prevention counseling, and it helped the doctor-patient relationship, Prochazka said. "Many physicians still favor comprehensive lab tests," he said. "That was a little bit of a surprise, in that most of the guidelines don't recommend that. They recommend tailored screening."

Prochazka's team found that of the 783 primary-care doctors responding to the survey, 65 percent believed an annual physical exam was necessary, in addition to seeing patients for acute and chronic conditions. Ninety-four percent believed that the examination improved the physician-patient relationship and provided time for counseling on preventive health behaviors. The vast majority -- 88 percent -- said they performed annual physicals. In addition, 78 percent believed most patients expected such an exam.

"There is a bit of a disconnect," Prochazka said. "Physicians may be responding to patients' desires. There may be some physicians who don't accept the guidelines. To me if you are really trying to prevent key diseases, you would really like everyone on the same page," he said.

Examinations should be tailored to individual patients, Prochazka said. "What's right for me as an individual may not be what's right for you," he said. "What you ought to be asking your physician is, 'What's the thing that's going to be the most benefit to me at my age?'"

Prochazka said doctors need to be educated about the guidelines to help them change their mindset about the annual physical.

Another expert agrees that the concept of the annual physical exam needs revising.

"Much of modern medical practice was established long before today's rigorous standards of 'evidence-based' care," said Dr. David L. Katz, associate clinical professor of public health, and director of the Prevention Research Center at Yale University School of Medicine. "Thus, much of what we do is founded on tradition, not evidence."

The annual physical is an example of this tradition-based approach, Katz said. "Despite its time-honored status and apparent appeal to patient and practitioner alike, the annual physical does not stand up well to the cold, objective glare of evidence-based scrutiny. The exam is low yield. How surprised are we to learn that tapping knee reflexes in apparently healthy 40-year-olds is about as likely to reveal pathology as a divining rod?" he said.

But traditions die hard, Katz noted. "As we work to remake the modern physical in the mold of evidence, we should not abandon the opportunity it affords for doctors and patients to spend time together," he said. "Rather, we should phase out perfunctory elements of little value, and replace them with those of known utility. Prochazka and colleagues point out that educating, and persuading, tradition-bound physicians will be an essential part of the process."

More information

To learn more about primary care, visit the American Academy of Family Physicians.

SOURCES: Allan V. Prochazka, M.D., M.Sc., professor of medicine, University of Colorado Health Sciences Center School of Medicine, Denver; David L. Katz, M.D., M.P.H., associate clinical professor of public health, and director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; June 27, 2005, Archives of Internal Medicine
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