If you are like many people, you probably do not look forward to your annual physical appointment. Taking time off from work, waiting in the doctor’s office, suffering through a battery of invasive tests and ever more invasive questions, all to find out that you are completely healthy is often more of an annoyance than anything. You might wonder “Wouldn’t it make more sense to just see the doctor when I am sick?” Turns out, you aren’t alone in questioning the value of annual physicals. Many health care professionals are also wondering whether it’s truly necessary for healthy adults to see the doctor every year — and some even suggest that healthy adults can wait as many as five years between appointments.
The Annual Physical: A Dying Breed?
Since the 1940s, the annual physical or wellness exam has been a cornerstone of health care in the United States. Doctors are trained to recommend an annual preventive care visit to all patients, regardless of their health, and most people oblige. In fact, 21 percent of all medical visits are for preventive care, making them the second most common reason that people visit the doctor. Doctors argue that annual visits serve several purposes. First, they provide a baseline view of a patient’s health, so if the patient gets sick, there’s a point of comparison from which to gauge the illness. Second, things change. Cholesterol and blood pressure readings can change drastically over the course of a year, and an annual physical can spot those changes. Finally, doctors like seeing patients annually because it helps them create stronger relationships. They don’t want to be meeting someone for the first time during an emergency, when they have little insight into the patient’s medical history, personality, or lifestyle. Still, despite physician support, there’s a growing body of evidence indicating that annual exams do not measurably improve overall health — and can actually cause greater harm, in some cases. A June 2014 article in the Journal of the American Medical Association detailed the story of one patient who saw his doctor for an annual exam which triggered a serious of increasingly invasive (and expensive) tests that not only put his life in jeopardy, but cost more than $50,000, only to discover that there wasn’t actually anything wrong at all. Experts note that the JAMA case was extreme, but that unnecessary post-annual exam testing is a common issue. Even in the course of a normal battery of preventive screenings, false positives (and negatives) create larger health care issues ranging from more invasive tests to severe anxiety. Moreover,according to , all that time, money, and stress isn’t doing any good. After a comprehensive review of 14 studies involving more than 180,000 subjects, the Cochrane Centre concluded that annual exams do not do anything to improve outcomes or prevent death. That conclusion is in line with the recommendations by the Canadian government going back to 1979, which recommended screenings and health maintenance plans for people at different phases of life, not a comprehensive annual exam.
Making Sense of the Recommendations
So does this mean that you never have to see your doctor again or deal with the dreaded prostate exam or mammogram? Not at all. What it does mean, though, is that you should talk with your health care provider to determine the best course of action for you. In general, though, many doctors believe that as long as you are in overall good health, do not smoke, and do not have any chronic conditions or major risk factors for disease, skipping the physical for a few years most likely will not do any harm. If you have a history of medical issues, though, or several major risk factors for disease, it’s important to check in with your doctor regularly. It’s also important to follow the screening guidelines as recommended by the U.S. Preventive Services Task Force (which actually does not recommend annual exams, but rather age-based screening tests) for health screenings. Tests for breast, prostate, and colon cancer, for example, are recommended by age 50 for most people. Doctors also recommend blood pressure and cholesterol tests annually, but note that these can often be accessed via clinics, workplace health centers, or at screening events without the need for a doctor’s appointment. Some predict that technology may soon make the debate about annual physicals moot. Doctors and patients are communicating via email or using apps to monitor test results, readings, and symptoms. In some cases, doctors are able to conduct consultations online and prescribe medications via an online pharmacy, making a trip to the office or even leaving the house unnecessary. At the same time, some suggest that with the implementation of the Affordable Care Act, which requires insurers to cover an annual physical for all members, the number of people who have been skipping their preventive visits due to the costs may be more inclined to make those appointments. The bottom line? If you are healthy, and your doctor agrees, you may be able to skip a few years between your annual physicals. Certain tests will always be important for maintaining your health, but you might be able to scratch one thing off your to-do list.