The Annual Physical Works In the Right Environment
Don’t look now but the annual physical is being questioned by the powers that be. This USA Today article tries to give all sides and opinions but the answer is in the eye of the beholder.
Pros:
• They help build relationships between doctors and patients.
• They are chances to fit in proven screening and prevention practices.
• They give all patients a reason to show up.Cons:
• Studies have found no evidence they reduce deaths or illnesses.
• They sometimes harm patients.
• They waste time.
• They waste money.Both sides agree upon: Relationships between doctors and patients are important and should be nurtured.
To me, as a Direct Primary Care doctor, I want to know my patients. These visits allow me to ask what they are doing positive in their lives. It gives me a chance to educate them on diet and exercise. Their time and my time isn’t wasted. Money isn’t wasted because they pay monthly whether they come or not. I truly doubt the right studies show we do harm. I know that I have found ways to reduce deaths and illnesses by picking up high blood sugar, abnormal moles, high blood pressure, etc. In other words, in the right environment these annual physicals are worth it. In the industrialized cattle environment, where patients are churned through, there is no way they could even see 20% of their patients for a physical per year. Maybe this is why some doctors don’t believe in it. I also wouldn’t be surprised if this is not another covert way to lessen the importance of doctors. Just saying.
Trust me I’m a PhD (and an MD) –
Research results are determined by the question asked.
If you go back to the original research – buried deep in the references in the references of the editorial – e.g. as below – then you will find the articles and the data they discuss (and read the references in these, especially the cochraine article) and find out how much ‘extrapolation’; is made to get the headlines of the likes of this article.
Boulware LE, Marinopoulos S, Phillips KA, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med 2007;146:289-300
Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care 2013;19:47-59
Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gotzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012;345:e7191-e7191
The government and Talking Heads are so two-faced about medical care it’s ridiculous.
They want “population-based medicine” but “patient-centered care”. They put annual wellness visits (what the hell does that mean?) in Obamacare, but now saying annual physicals are worthless.
They talk about the benefit of Primary Care to healthcare in general but try to drive PC out of business with PCMH, outrageous mandates and dwindling payment schemes.
I can tell you the DOT requires biennial physicals on all its drivers and we catch many with undetected Diabetes, Hypertension and a few other surprises. Gee, if I catch a hypertensive early on, don’t we think that will reduce the future possibility of renal failure, CVA or MI?
Nahh, guess not.
“we catch many with undetected Diabetes, Hypertension and a few other surprises. Gee, if I catch a hypertensive early on, don’t we think that will reduce the future possibility of renal failure, CVA or MI?”
You don’t get it. You’re supposed to do all of that plus all the other screenings, including Paps, breast exams, immunizations, etc. when they come in for a sinus infection. That way, you’re doing it all for free. Very cost effective.
Ahhh, silly me.
Yes, and no.
Yes – for the annual visit with the physician. For persons with even one or two chronic issues, this is barely enough. The well physical is a time to gather the risks to the person’s health and rank them according to seriousness. That skill is being lost, as the primary care visit is increasingly becoming an assembly of meaningless data, followed by unthinking consultation and/or ER visits. Through DPC, this meeting – which ought to go on perhaps more frequently than annual – keeps the patients well.
No – to the industrial redefinition of “physical,” i.e. the intensive ballet of the comprehensive examination of the well patient, looking for clues to occult illness. Unfortunately, many patients consider this to be a “complete physical,” in the way that churning over the Review of Systems every year somehow imparts magic by the checking-off of dozens of boxes of normal replies.
Go through a bewildering and complex history of absent symptoms – and document an intensive and broad-based examination for normal findings. Throw in a spattering of unconsidered lab data. Return in a year.
That formula is a recipe for documenting missed findings that could, and should, have been attended to. In the turbo-annual, it is the ritual of the performance of doctoring that makes patients feel better, even though there is rarely a chance of finding something.
Which part is disappearing, and which part is coming to the forefront? It is obvious.