Physicians Find Annual Exams Valuable Despite Lack of Evidence
A complete annual physical exam is a routine checkup for people age 18 and older who have no medical complaints. It became popular in the 1920s as a way to identify people with disease before they showed symptoms, and is the most common reason people visit a doctor.
There is currently a lack of evidence supporting complete annual exams, and national organizations have stopped recommending them. In addition, they are costly and can expose patients to unnecessary risks if they lead, for example, to invasive tests and treatments that prove unnecessary. Instead, current guidelines suggest more focused screening examination—like ]]>Pap smears]]> and ]]>blood pressure checks]]> —based on a patient’s health status and risk factors. Nevertheless, studies have shown that many patients want to be examined from head to toe on a regular basis and insurance companies are still willing to pay for these comprehensive exams.
Researchers interested in physician attitudes and practices regarding complete annual exams published their study results in the June 27, 2005 edition of the Archives of Internal Medicine , a publication of the American Medical Association. Overall, they found that physicians are still performing these exams because they find them valuable for a number of reasons.
About the Study
The study was conducted by a team of researchers from the Denver Veterans Affairs Medical Center that had previously studied public expectations and attitudes about annual physical examinations.
The team sent a survey to 1,679 primary care physicians (PCPs) practicing in three geographic areas—Boston, Massachusetts; Denver, Colorado; and San Diego, California—who specialized in internal medicine, family practice, or obstetrics/gynecology. The survey included questions about physician attitudes and practices regarding, physical examinations, laboratory testing, and diagnostic procedures.
Of the 783 physicians who responded (47%), most believe that an annual physical examination is valuable. Nearly all of those who responded (94%) believed that it created a more positive physician-patient relationship and provided time for counseling on preventive health behaviors. Eighty-eight percent of PCPs indicated that they performed the exams, and over three-quarters believed that patients expected them to.
Despite evidence to the contrary, 74% of the respondents thought that the annual exam could reliably identify illnesses that hadn’t yet developed symptoms, 63% thought the exams were proven valuable, and over half thought national organizations recommended them. A possible limitation of the study was the wide variability in the components of the physical exam practiced by the respondents. Not surprisingly, doctors disagreed on what they consider to be “complete” physical exams. Another limitation was the response rate of only 47%. While this is typical of physician surveys, researchers have no way of knowing if those who responded hold views similar to those who did not.
How Does This Affect You?
While physicians and patients seem to agree that complete annual exams offer some benefits, there is no evidence that they can be expected to improve health. It’s important to emphasize, however, that certain parts of the physical exam do have value. Regular Pap smears in women and blood pressure checks in all adults, for example, have been shown to reduce the risk of death from ]]>cervical cancer]]> and ]]>hypertension]]> respectively. And many individual patients have surely benefited from the early detection of a cancer or other serious problem by physical exam. But performing maneuvers like listening to the heart or pressing on the abdomen year after year should not be expected to improve the lives of the vast majority of patients.
Still, a persuasive argument can be made that performing a thorough exam during the first visit to a new doctor provides valuable baseline information. However, since lifestyle has the most direct impact on health, patients would probably be best served during subsequent visits by focusing on subjects like diet and exercise, tobacco cessation, and seat belts use, rather than the poking and prodding of a complete physical.
American Academy of Family Physicians
American Cancer Society
American College of Obstetrics and Gynecology
American College of Physicians
Centers for Disease Control and Prevention
U.S. Preventive Services Task Force
Kolata, Gina. Annual physical checkup may be an empty ritual. New York Times . August 12, 2003.
O’Malley, PG. Editorial, The annual physical: Are physicians and patients telling us something?. Archives of Internal Medicine. 2005;165:1333-4.
Prochazka, AV, Lundahl, K, Pearson W., et al. Support of evidence-based guidelines for the annual physical examination. Archives of Internal Medicine. 2005; 165:1347-52.
Last reviewed Jun 29, 2005 by ]]>Richard Glickman-Simon, MD]]>
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