Maybe You Should Skip That Annual Physical | KUOW News and Information

Maybe You Should Skip That Annual Physical

Apr 6, 2015
Originally published on April 6, 2015 11:10 am

It's a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care for a physical exam. Dr. Mark Caruso shakes his hand with a welcoming smile.

Vega, a strapping man with a thick black beard, is feeling good, but he came to see the doctor today because his wife thought he should. She even made the appointment. It is free to him under his insurance policy with no copay, as most preventive care is under the Affordable Care Act.

Vega is one of more than 44 million Americans who is taking part in a medical ritual — visiting the doctor for an annual physical exam. But there's little evidence that these visits actually do any good for healthy adults.

Caruso listens to Vega's heart and lungs, checks his pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise and sleeping schedule and orders blood and urine tests. If everything checks out all right, Caruso says, Vega should return for another exam in a year. Vega says he definitely will.

It was a positive experience for both doctor and patient. But many other doctors think the annual physical is unnecessary and can even be harmful.

"I would argue that we should move forward with the elimination of the annual physical," says Dr. Ateev Mehrotra, a primary care physician and professor of health policy at Harvard Medical School.

Patients should really only go to the doctor if something is wrong, Mehrotra says, or if it's time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view.

"When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm attacking moms and apple pie," Mehrotra says. "It seems so intuitive and straightforward, and [it's] something that's been part of medicine for such a long time."

But he says randomized trials going all the way back to the 1980s just don't support it.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid completely for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but with so many people getting them, that adds up fast.

"We estimate that it's about $10 billion a year, which is more than we spend as a society on breast cancer care," Mehrotra says. "It's a lot of money."

Then there's the risk that a doctor will run a test and find a problem that's not actually there. It's called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He tries to avoid giving physicals.

"I generally don't like to frighten people, and I don't like to give them diseases they don't have," Rothberg says. "I mostly tell my family, if you're feeling well, stay away from doctors. If you get near them, they'll start to look for things and order tests because that's what doctors do."

Back in Miami, Caruso is also well versed in the research on annual physicals, but he still believes in them. "I think having a look at somebody is worth its weight in gold," he says.

It's an important part of developing a relationship with a patient, he says, and there have been countless times over his career when he's found real problems during an exam just like the one he gave to Emanuel Vega.

"What if Mr. Vega had had a lump or bump that wasn't right?" Caruso says. "What if when he had his shirt off Mr. Vega said, 'Oh yeah, I forgot to mention this spot on my chest,' and it ended up being a melanoma we discovered early?"

And Vega did end up needing a little help; he has a bad back that's landed him in the emergency room several times. Caruso was able to link him up with a back specialist to help him manage the problem.

Copyright 2018 Kaiser Health News. To see more, visit Kaiser Health News.

RENEE MONTAGNE, HOST:

Today in Your Health, two questions about when one should seek medical care. In a moment - why many women don't seek help during a heart attack. First, a medical ritual for millions of Americans - the annual physical, yearly prodding and poking with questions about exercise and alcohol intake. There is little evidence to show these checkups do any good for healthy adults, and they may be worth skipping altogether, as Jenny Gold reports.

JENNY GOLD, BYLINE: It's a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care for a physical exam. He's a handsome and strapping guy with a thick, black beard and square glasses. Dr. Mark Caruso shakes his hand with a welcoming smile.

MARK CARUSO: Mr. Vega, I'm Dr. Caruso, a pleasure to meet you.

EMANUEL VEGA: Very nice to meet you.

CARUSO: And when was your last full diagnostic?

VEGA: Wow, I don't even remember - probably 12-13 years ago.

GOLD: He says he didn't really feel like he needed to come in.

VEGA: I am feeling good. I don't do drugs. I don't drink. My wife went ahead and made the appointment, and I was all about it.

GOLD: Especially because it's free under his insurance policy - not even a copay. Dr. Caruso starts with the basics.

CARUSO: Open please. Say ah.

VEGA: Ah.

GOLD: He listens to Vega's heart and lungs, checks the pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise routine - impressive - his rest schedule could use some work - and orders blood and urine tests. As long as everything checks out all right, they'll do it all again next year.

CARUSO: We'll ask one year - allow us to do this full diagnostic.

VEGA: Yeah, yeah, sure, of course

GOLD: Vega says he'll definitely be back. More than 44 million Americans get a physical exam each year, but as it turns out, the evidence is not on their side, says Dr. Ateev Mehrotra, a professor of health policy at Harvard Medical School.

ATEEV MEHROTRA: I would argue that we should move forward with the elimination of the annual physical.

GOLD: Mehrotra is also a primary care doctor. He says patients should really only go to the doctor if something is wrong or if it's time for them to have an important test, like a colonoscopy.

MEHROTRA: When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm, you know, attacking moms and apple pie here. It's - you know, it seems so intuitive and so straightforward and something that's been part of medicine for such a long time.

GOLD: But he says randomized trials going all the way back to the 1980s just don't support it.

MEHROTRA: They don't really help patients.

GOLD: The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid completely for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs just $150, but with so many people coming in every year, that adds up fast.

MEHROTRA: We estimate that it's about $10 billion a year, which is more than how much we spend as a society on breast cancer care. It's a lot of money.

GOLD: And then there's the risk that a doctor will run a test and find a problem that's not actually there. It's called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. Dr. Michael Rothberg is a health researcher at the Cleveland Clinic. He says, as a doctor, he generally avoids giving physicals.

MICHAEL ROTHBERG: I generally don't like to frighten people. And I, you know, mostly tell my family if they're feeling well to stay away from doctors because, you know, if you get near them then they're going to start to look for things and order tests 'cause that's what doctors do.

GOLD: Back in Miami, Dr. Caruso is also well-versed in the research on annual physicals, but he still believes in them.

CARUSO: I think having a look at somebody is worth its weight in gold.

GOLD: He says it's an important part of developing a relationship with a patient. And there have been countless times when he's found real problems during an exam, just like the one he gave to Emanuel Vega.

CARUSO: What if Mr. Vega had had a lump or bump that wasn't right? What if when he had his shirt off Mr. Vega said oh, yeah, I forgot to mention this spot on my chest and it ended being a melanoma that we discover early?

GOLD: The federal government seems to agree. The Affordable Care Act requires all insurance plans to cover annual physicals at zero cost to patients. For NPR News, I'm Jenny Gold. Transcript provided by NPR, Copyright NPR.