Annual Physical Exam: Unneeded Expense?

New Research Adds To Debate About The Value Of A Yearly Physical

(WebMD)  An annual physical exam is a tradition for many U.S. adults, but it is not always necessary, according to a new study.

"I'm not advocating we should get rid of these visits," says researcher Ateev Mehrotra, MD, assistant professor of medicine at the University of Pittsburgh School of Medicine and a policy analyst at RAND Corp.

Rather, the preventive services and tests ordered at these exams that are actually necessary often can be received at other visits and times, says Mehrotra. The study is published in the Sept. 24 issue of the Archives of Internal Medicine.

Using two national surveys, Mehrotra and his colleagues analyzed 8,413 doctor visits for preventive health exams (annual physicals) and preventive gynecological exams, which women schedule to get Pap tests and pelvic exams. The doctor visits too place from Jan. 1, 2002, to Dec. 31, 2004.

Among the findings:

• About 44.4 million adults, or nearly 21 percent of the population, get a preventive physical exam annually.
  
• About 19.4 million women, or about 18 percent of adult women, get a preventive gynecological exam annually.
  
• Together, these account for 8 percent of all doctors' office visits. If every U.S. adult got an annual physical, the U.S. health care system would need to provide up to 145 million additional visits annually, the researchers estimate.
  
• Most preventive care, about 80 percent, was received outside the preventive exams, when the patient saw the doctor for other reasons.
  
• The cost of providing both types of routine exams was about $7.8 billion, almost the amount spent for breast cancer care in the United States in 2004.
  
• More than a third of the annual physicals in the study included testing such as complete blood cell counts or urinalysis, which Mehrotra says are not proven to improve patient outcomes when performed routinely and so may be unneeded. Complete blood cell counts and urinalysis cost about $192
  million a year in the study.
  
• The annual physicals and preventive gynecological exams, however, were the most common avenue for getting certain crucial tests such as mammograms and Pap tests.
  
• The number of adults getting the annual physicals varied by region, reflecting differing beliefs and practices. "Those in the Northeast have a 60 percent increased chance of getting a physical compared to those on the West Coast," Mehrotra tells WebMD.
  

Annual Physical Exams: The Ongoing Debate
The discussion about whether an adult needs an annual physical has been ongoing for nearly a century, Mehrotra tells WebMD. Currently, no major North American health-related organizations recommend the routine annual exams, he says.

Still, many patients as well as many doctors believe the annual visits are a medical necessity. "The vast majority of people think they are being good patients if they go in to see their doctor every year," says Mehrotra. "Most doctors actually believe the same thing."

Yet, the value of the exams has not been established in studies, he says.

"We need to figure it out," Mehrotra says. "Do people need to come in for a special visit? Can't we do a lot of these services at other times, without the need for a [special] visit?"

The new study, he says, suggests that crucial preventive services can easily be received during other visits, and often are.

Second Opinion
The study provides some valuable information, says Douglas K. Owens, MD, a senior investigator at VA Palo Alto Healthcare System and professor of medicine at Stanford University. "The researchers are saying these [annual physicals] are common, often provide preventive services, but that many preventive services are provided at other visits"

"It is important to understand what these exams accomplish," he says, "and that there are other ways to accomplish the same thing that might be more efficient and cost-effective."

Owens chairs a subcommittee of the American College of Physicians that develops guidelines about treatment and care but says he is giving his opinion, not that of the college. The ACP has no official guideline about the annual physical, he says.

Some advocates of the annual physicals see the yearly exam, Owens points out, as a good way to build the patient-doctor relationship. Yet that relationship can be worked on, others say, in any doctor office visit, not just the traditional annual physical visit.

Take-Home Points on Annual Physicals
What's the message for patients? "The important thing for consumers is, there are preventive services important to get," Owens says. "If they are getting them as part of their routine care, that is great. If not, a periodic health exam may be a good avenue to get them."

"Have a conversation [with your doctor]," Mehrotra suggests. "If your doctor tells you [that] you don't need to come in for an annual physical or don't need some of these tests, he's not [just] trying to save money. Patients should realize there is a lot of controversy about the value of physicals and they should have a conversation with their doctor about it."

Patients should also realize, he says, that the preventive services they absolutely need can be received outside the traditional annual physical exam.


(Do you get an annual physical? Why or why not? Talk with others on WebMD's Health CafC) message board.)

[iceman_1960]

Great website for a daily visit:

Health News

http://www.webmd.com/news/default.htm

[obiwan234]

I also believe that the traditional annual physical exam my be a waste of time and money, in most cases however it flys in the face of preventative medicine. We also have to believe that or doctors are at least above the norm, some however didn''t get all A''s in medical school and many deliver poor medical care.

I had a annual physical exam up until I was 50 and the last ten years I have only had one every two years and my doctor missed a heart condition and prostate cancer despite proper testing, he is responsible for my not getting the care I should have had, his lack of doing a proper job almost killed me. Just remember under takers bury many doctors mistakes.

Thankfully, I fired the idiot doctor and I got good surgeons and insurance to cover most of the $1,004,000.00 in medical bills this year. I had a four way by-pass, cancer surgery and a pacemaker, all in a 6 month period of time.

[barbaraf4]

So the medical profession is going to kill another sacred cow. It seems like we keep paying more and more for our benefits and receiving less and less value. Our annual physicals and associated tests (labs, mammo, bone density, etc.) used to be covered 100%. This year, they are in the 80%/20% and they pass through that God awful $1,000 deductable. As it turns out, all I had was a physical this year and I ended up paying for all of it.

[drivelphobe]

Treating healthy people is just another revenue builder for the medical practitioners. Don''t go to the doctor unless you are sick or hurt. That''s it.

This preventive care business is just a ruse to keep the waiting rooms full. The poor sick and injured suffer for this by having to wait for treatment. If insurance didn''t have to help pay for all the "preventive care" and routine annual physicals, our premiums would go down substantially. It''s all a scam created by the AMA. What a great idea. If you can''t make enough money treating the sick and injured, let''s find a way to get healthy people in for care. Preventive medicine, the physican''s best friend. Annual physicals are a joke.

[michellem99-2009]

I don''t get a phyiscal exam as they won''t pay for it.

[jemmers-2009]

"...preventive care business is just a ruse to keep the waiting rooms full"... exactly and then if they don''t kill you sooner, they might later...(latest research indicates "when extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors.3 The results of the New York Study suggest the number may be as high as 98,000.4 Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th-leading cause of death.5 More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516)." From To Err Is Human: Building a Safer Health System (2000)Institute of Medicine. So, be careful out there, just because its a doctor or a hosptial does not mean that all is good, right, or without additional costs.
By the way, the minimal guestimate far exceeds all highway deaths in the US annual and certainly all deaths caused by handguns... fact check.

[connapa]

Just as with all "Traditions", the origin of the tradition of getting an annual physical is shrouded in mystery. If you ask doctors, you will probably get varying reasons why one should do an annual physical. For the overwhelming majority of people who get them, it is likely a waste of time, money and doctors'' resources (not to mention insurance companies''). There is proven benefit to many screening procedures such as mammograms, Pap smears, colonoscopies, etc. Others such as lab testing for early onset diabetes and for cholesterol screening is also of benefit. Granted, some problems will be missed with certain routine screenings. If all the doctors in the world followed all the recommended screenings, that would be more cost effective, in the long run, than continuing annual physicals with generally healthy adults. (Routine periodic exams with pediatric patients are an exception, though.)

[mrassekh]

Who can afford an annual exam? I can barely afford to see a doctor when I''m ill.