Is the Annual Disease Check-up Past Its Prime
Friday, January 30, 2015 10:14 PM

Few medical societies still recommend healthy adults undergo annual physicals, and some groups actively recommend against them, yet many physicians continue to offer the visits to their patients, and the debate over the necessity of the annual physical continues. 

According to one MD, recent estimates say about 45 million Americans will have a routine general physical this year, which he likens to the human equivalent of the 15,000-mile check-up on their cars. "If you estimate the cost of the exam alone conservatively at $100, it's beginning to be a nontrivial amount of money.”  And that is before you add in the costs of laboratory panels, follow-up tests, patient anxiety, and the overdiagnosis or overtreatment of conditions that, if left undetected, would never have become clinically significant. He writes, "If you screen thousands of people, maybe you'll find tens whose exams suggest they might have a disease. And then upon further tests, you'll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis.”  From a health-promotion perspective, then, the annual physical exam is of little value, does not reduce morbidity and mortality from acute or serious chronic conditions, and may even lead to unwarranted complacency in "people who just want to make sure,” he said 

To support that statement, Dr Emanuel points to evidence from a 2012 Cochrane Collaboration review of 14 randomized controlled trials involving 182,000 people followed for a median of 9 years. The unequivocal conclusion of the analysis was that routine general check-ups, not prompted by actual symptoms, are unlikely to yield much benefit. No matter what screenings and tests were administered, annual physicals did not reduce mortality.

More recently, data from a large, randomized trial, supported the conclusion that general check-ups are ineffective. The community-based trial of almost 60,000 adults aged thirty to sixty years, with screening for ischemic heart disease risk and repeated lifestyle interventions over the course of 5 years, found no effect on ischemic heart disease, stroke, or mortality at the population level after 10 years.

"Doctors are already saying they don't have enough time for all their patients, so with annual check-ups, you're devoting time to exams in healthy asymptomatic people who probably don't need them,” the MD said.  Avoiding annual exams would free up many physician-hours for patients with manifest acute or chronic medical problems.  He concedes, however, that even healthy, "never-sick-a-day-in-my life" people should check in with a physician once in a while.  At that time, appropriate evaluations can be made, he notes, but many US physicians continue to offer this annual staple, motivated, he said, by a combination of financial considerations, habit, and patient expectations.