No Annual Exams?
Written by Editor   
Wednesday, April 30, 2014 07:11 AM

A recommendation from the Society of General Internal Medicine to do away with annual checkups for asymptomatic adults evoked strong emotions.  SGIM was asked by the American Board of Internal Medicine (ABIM) Foundation to make recommendations for its Choosing Wisely campaign. The initiative involves 47 medical groups and societies that were asked to identify five tests or procedures commonly used in their fields in an effort to "spur conversation about what is appropriate and necessary treatment" between patients and clinicians, according to the foundation.

One of the SGIM recommendations -- "Don't perform routine general health checks for asymptomatic adults" -- upset a large number of SGIM members.  "The lack of evidence [for annual checkups] is obviously not evidence of the lack of benefit," one member said. "I don't agree with the recommendation."   Many members pointed out a distinct difference between annual screenings and tests, and the human interaction involved with an annual checkup.  "Routine use of several testing methodologies that had been part of the routine physical exam has very little value. But to conclude that the visit doesn't have value is a stretch," one member said.

As SGIM is comprised of physicians affiliated with academic medical centers, they pride themselves on practicing evidence-based medicine. And that's exactly how the committee approached their list of five, which was voted on and passed unanimously by SGIM leadership.  SGIM's ad hoc committee looked at randomized clinical trials, Cochrane reviews, and a high-quality systematic review -- involving over 150,000 patients -- and found no clear benefit to annual health checkups for healthy, asymptomatic adults.

In a Consumer Reports Health synopsis called "Health Checkups: When you need them -- and when you don't," annual checkups were made to seem superfluous and potentially dangerous: The synopsis had an entire section with the title "Tests and screenings can cause problems."

SGIM, and one of the radiology groups, were the only two participating societies that made recommendations that affected their own members' finances.

In contrast, "participating societies generally named other specialties' services as low-value," according to a New England Journal of Medicine (NEJM) perspective article.

David U. Himmelstein, MD, an outspoken member of Physicians for a National Health Program, an organization that advocates for a single-payer national health system, criticized the recommendation and the data that the ad hoc committee used to make their decision.