Are annual physicals really necessary?

Authors of a recent article, published in the journal Annals of Internal Medicine, stressed the importance of routine physicals not only for health reasons, but the patient-doctor relationships the annual exams help build.

Researchers examined 33 studies of periodic health evaluations that consisted “only of the history, risk assessment, and a tailored physical examination.” Evidence showed that the periodic exam improved delivery of some recommended preventive measures and may lessen patient worry.

Such routine visits have led to new diagnoses of melanoma, colon and breast cancer, alcohol abuse, opiate addiction and depression – diagnoses that would otherwise have been delayed or missed, according to the article.

“Intimate knowledge of our patients and their changing life circumstances, priorities, and perspectives is the indispensable foundation of good, patient-centered care,” Dr. David U. Himmelstein and Dr. Russell S. Phillips wrote. “’Routine’ visits offer opportunities to explore patients’ mental states, glean subtle clues of substance misuse or deteriorating health, and form bonds that allow patients to trust us with sometimes painful secrets.”

The authors agreed that more research is needed on the value of routine exams, “but in the meantime, pulling up that anchor, particularly for our disadvantaged patients, is a short-sighted fix to problems that require more thoughtful solutions.”

Dr. Ashwani Garg, a family medicine physician on staff at Elgin, Ill.-based Advocate Sherman Hospital, says that many routine screenings do little to actually decrease the death rates from the top diseases, meanwhile probably half of cancer, heart disease and stroke deaths may be due to lifestyle.

“What I would argue for is to shift the focus of the [routine physical] to more of an active approach to overhauling someone’s lifestyle,” he says. “However, if you conduct a comprehensive risk assessment, and an intervention including diet, exercise and stress management, then that [annual] visit will carry much more weight and probably make a great influence than just the preventative exam.”