Last Update: Thursday, November 28, 2013
|LIFELONG HEALTH- Study: Annual Physical Too Focused on Disease|
|Written by Dr. David Lipschitz|
|Thursday, 08 November 2012 07:41|
Starting at age 50, an annual physical is recommended. In the population served by Medicare, an annual wellness visit is fully covered with no copay by the patient. What could be more important than having an opportunity to sit down and discuss problems with your physician and to make sure you do not have some hidden disease?
You need to be more educated about how to stay healthy through diet, exercise and stress control. And, just as critically, you need to know how to navigate the complex health care system should you become ill. Through examination, laboratory tests and obtaining your history, medical problems can be identified, high blood pressure treated and cancer diagnosed at an earlier, more curable time. 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. The researchers found the exams did not reduce the risk of deaths from heart attacks and cancer compared to those who did not have an annual physical. 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 and identifying abnormalities that required a biopsy or even surgery that turned out to be of no clinical significance — the socalled false positive.
In this study, 182,880 people 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 admissions to the hospital, referrals to specialists 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. In another, more drugs were taken to treat high blood pressure, but remarkably, this did not measurably affect health outcomes.
In an accompanying editorial, Dr. Stephanie Thompson and Dr. Marcello Tonelli from the University of Alberta state 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. They raised concerns that screening tests are often not needed and should be done only when 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 cursory or nonexistent, 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, the more the potential harm. The answer, though, is not to forgo but to improve the annual physical.
Too much time is spent seeking disease and too little on education. A wellness visit may be needed only 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 (thin, overweight or obese) on how to eat right and maintain an ideal weight. An expert should develop an exercise plan, and everyone should learn how to deal with stress, a potent cause of many diseases. As 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 dietician 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
|Last Updated on Thursday, 08 November 2012 07:55|