Last Update: Wednesday, August 27, 2014
|Seeing Your Doctor for an Annual Physical May Be of Little Value|
|Written by Dr. David Lipschitz | Creative Syndicate|
|Thursday, 15 May 2014 00:34|
From age 50 onward, an annual physical is recommended. And for the Medicare population, an annual wellness visit without a copay is fully covered. What could be more important than having an opportunity to sit and discuss problems with your physician to make sure you don't have some hidden disease that over time can do you harm?
We need to be more educated about how to stay healthy through diet, exercise and stress control, and just as critically, how to navigate the complex health care system should we become ill. Through history, examinations and laboratory tests, medical problems can be identified, high blood pressure treated and cancer, if present, diagnosed at a much earlier time when it is more curable. The annual physical is the holy grail of medicine.
And yet, in a review published in the prestigious Cochrane Library, researchers from Denmark found that annual physical examinations prevented nothing. They did not reduce the risk of death from heart attacks or cancer, as compared to patients who did not have annual physicals. Furthermore, there was no difference in life expectancy between the two groups. The researchers even suggest that an annual physical may cause more harm than good by performing needless tests, which sometimes identify abnormalities that require biopsies and even surgery, but turn out to be of no clinical significance -- the socalled false positive.
In this study, a total of 182,880 were followed for an average of nine years. Some had annual physicals and others did not. Not only was there no difference in death rates, heart disease or cancer, but hospital admissions, disability, specialist referrals and quality of life measures were identical in the two groups. In one study, annual physicals led to a 20 percent increase in the number of medical diagnoses, and in another, more drugs were taken to treat high blood pressure, but remarkably they did not, in any way, affect health outcomes.
In an accompanying editorial, Dr. Stephanie Thompson and Dr. Marcello Tonelli make the statement that the annual physical, with its additional screening tests, may be of so little value as to be labeled a waste of precious health care dollars. In their editorial, they raise concerns that screening tests are often not needed and should only be done based on sound scientific evidence of benefit and modified depending on the patient's age, sex and the presence or absence of other risk factors.
Anyone who has gone to more than one doctor knows that there is little uniformity in the annual physical examination. Conversation between patient and doctor may be short. The examination may be nonexistent or cursory, and there is usually an overemphasis on blood tests and X-rays. Counseling about good nutrition, exercise plans, smoking, weight reduction and stress management are too time-consuming to be truly reviewed in detail.
Clearly this new research questions the value of the annual physical and raises concerns that the more tests done, the less the benefit and the more potential harm. The answer, though, is not to forgo but to reform the annual physical. Too much time is spent seeking disease and too little on education. To be truly effective, a wellness visit should take a "village" to accomplish its goals and may only be needed every few years. The doctor must perform a comprehensive history that covers medications taken, recent illness, family and social history. Following a careful examination, prudent testing should be done to assure that the most appropriate treatment plan is developed. Just as critical is counseling everyone (the thin, the overweight and obese) on how to eat right and maintain an ideal weight. An expert should develop an exercise plan, and lastly, everyone should learn how to deal with stress, a potent cause of many diseases.
As more and more physicians become affiliated with hospitals, the potential of a true team approach to the "annual physical" can become a reality. Depending on particular issues, some team members may have more involvement than others. For example, the dietitian is critical to the care of a patient with borderline diabetes. If this plan is ever implemented, future research may well show that the effort is well worth the investment.
Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit www.drdavidhealth. com