March 10, 2016
The Annual Physical: Is There Benefit?
An article was recently published in USA Today discussing the importance or lack thereof of the annual physical exam. The article did not go out on a limb to support one side or the other but seemed to be trying to make the public aware that there are different schools of thought. However, both sides cited the lack of good studies to support the need for annual physical exam. In 2013, the Society of General Internal Medicine put “routine health checks” on the list of practices not recommended as they lack studies supporting their value.
Perhaps the physical exam just needs to be renamed. These visits serve a greater purpose than simply a physical examination. In fact, the examination portion is often the least time-consuming part of the visit. Much of the visit is spent catching up on the patient's health issues over the past year and reviewing health maintenance issues such as what immunizations or screening tests (eg, colonoscopy) may be needed. It is also a time to continue to grow the relationship between provider and patient. Annual physical examinations are rarely “routine” as most people have something they wish to address in addition to those issues on their “problem list.”
I can think of many instances when an annual exam has benefited my patients. Years ago, during a follow-up visit with a patient, I noticed he hadn't come in for an annual visit for several years. He responded that his practice is to come in when he needs me. I advised him that while I don't mind putting out fires, I prefer to prevent them in the first place. The patient eventually starting coming in annually and at one of the physical exams, while performing a thorough skin check, malignant melanoma was identified. Its depth was fortunately shallow and he has done remarkably well following treatment. By the way, that annual skin check performed during the physical examination is not supported by evidence-based studies according to the US Preventive Services Task Force.
Evidence-based guidelines are obviously important and are helpful in guiding clinical practice; however, so is common sense. My problem with some evidence-based guidelines is that they seem to focus on the needs of the many instead of the needs of the few. The patient in front of me may be one of the few. As physicians in primary care, we need to think of evidence-based medicine and how it applies—or maybe not—to the patient in front of you. As a rule, I encourage my patients to undergo an annual physical exam. I am fairly confident that too much follow-up is safer than too little, for both patient and provider.