In his NYTimes op-ed, Dr. Ezekiel J. Emanuel states that in the new year and years to come, he will continue to get an annual flu shot, eat healthy, exercise, and get a colonoscopy every 10 years. But one thing will change his medical routine will no longer include an annual physical exam. He asserts, From a health perspective, the annual physical exam is basically worthless.
Although this seems quite counterintuitive, Dr. Emanuel argues that although many people view a physical exam as the equivalent of a 15,000-mile checkup and fluid change. But an annual exam does not work the same way it does not uncover hidden problems that ensure longer engine life. And there s evidence to back this up: in 2012, the Cochrane Collaboration, an international group of medical researchers, analyzed 14 randomized trials following over 182,000 people for about 9 years. They sought to evaluate the benefits of routine check-ups (not prompted by any symptom) and found that physical exams were unlikely to be beneficial. Annual physicals did not reduce mortality overall or for specific causes of death.
The lack of evidence in favor of physical exams reducing morbidity and mortality is the main reason why the United States Preventive Services Task Force (USPSTF) does not have recommendations for routine annual exams (Canada s analogous group has rejected the annual PE since 1979). And while some may think there is still no downside to receiving annual checkups, Dr. Emanuel states that they consume billions of dollars and divert countless hours of doctors time away from patients who are actually ill, instead, wasting it on patients who have no medical problems. The reason doctors and patients don t seem to want to change this routine is partially psychological it s hard to change something that is habit, and people worry that they may miss a major medical problem if they skip the exam. But the reality is that screening healthy people with no complaints is largely ineffective in improving health or prolonging life.
ACSH s Dr. Gil Ross, who performed countless routine annual exams over his 20-year career in internal medicine, had this to say: Such an advisory would have led to Dr. Emanuel s being excommunicated from the medical brotherhood in the 1970s and 80s. But now that we are taking long, hard looks at the risks and benefits of everything we used to simply accept as holy writ, the data expounded upon in his op-ed cannot be contested scientifically. Yet, I d be among the first to see how difficult it is, for both clinicians and patients, to abandon long-held beliefs and habits (see for instance the trends in PSA tests and mammograms). Still, it must be done, for doctors, patients, and our health care economy.
