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Routine check-ups provide no health benefits, study finds

We've heard it all before when it comes to our health: Getting a routine check-up is the best way to stay healthy and ahead of disease.

A new study from researchers at the Cochrane Library finds these physicals won't benefit patients' health or reduce their risk for chronic disease or dying.

So much for prevention being the best medicine?

"From the evidence we've seen, inviting patients to general health checks is unlikely to be beneficial," study author Lasse Krogsboll, a researcher at the Nordic Cochrane Centre in Copenhagen, Denmark, said in a press release. "One reason for this might be that doctors identify additional problems and take action when they see patients for other reasons."

A routine check-up was one of the two most common reasons patients visited their doctor in the U.S. in 2009, according to Stephanie Thompson and Marcelo Tonelli, two researchers from the University of Alberta in Canada who wrote an accompanying commentary on the study. However, they note leading medical organizations including the U.S. Preventive Services Task Force haven't recommend annual check-ups since 1989.

"Concerns about overdiagnosis notwithstanding (and despite the national guidelines), general health checks are considered by physicians and the public as both necessary and recommended," Thompson and Tonelli note.

For the study, Cochrane researchers reviewed 14 trials involving nearly 183,000 people. The trials all involved one group of participants who were assigned to receive general check-ups and another group that was not.

One of the studies found routine check-ups led to more diagnoses of all kinds, while another found people who got physicals were more likely to be diagnosed with high blood pressure and cholesterol.

Nine of the studies reported a total of 11,940 deaths, but an analysis showed no long-term difference in odds of dying in both groups, either overall death risk or due to cancer and heart disease. The review also found that routine check-ups had no major impact on hospital admissions, disability, specialist referrals, additional visits to doctors or time off of work.

"It is generally recognized that screening should be based on evidence from randomized trials showing a favorable balance between benefits and harms," Krogsboll told TIME." In our review we could not find that, and we therefore cannot see any justification for public health programs pushing for routine health checks."

Dr. Michael LeFevre, co-vice chair of the U.S. Preventive Services Task Force, a group of medical advisors to the government that make guideline recommendations, told WebMD that one of the reason check-ups may not have worked is the review included studies from the 1960s and 1970s, when doctors ordered many tests during wellness exams.

The Task Force in recent years has recommended against prostate cancer screening for healthy men who aren't risk, breast cancer screening through mammograms for women in their 40s, and EKG screening in healthy people to see if they're at risk for heart problems.

The group has however recently recommended screening adult patients for obesity, since modest weight loss can reduce health risks.

Dr. L. Ebony Boulware, a professor of medicine at Johns Hopkins School of Medicine in Baltimore, told The Wall Street Journal that checkups could be beneficial in getting people to think about their health.

"What may be very important about these exams is that they provide an opportunity for patients to get together with their health-care providers, talk about their health risks and plan for getting recommended tests," she said.

Dr. Bradley Flansbaum, a hospitalist faculty at Lenox Hill Hospital in New York City, told the idea of symptom-free individuals getting a soup-to-nuts yearly check-up complete with lab tests and a stethoscope may be engrained in our culture as a mentality that everything a doctor does will add helpful information about health, but that is not always the case.

"I can't say that it deviates too greatly with what the house of medicine has been saying for quite some time."

Flansbaum says doctors that have a scripted approach to a check-up at best may not add much to the patient's health and at worst could harm patients and cause needless expense to the system.

Nine leading medical societies unveiled in April a campaign called "Choosing Wisely," warning doctors and patients to question "routine" medical tests that contribute to billions of dollars in unnecessary health care costs.

However, Flansbaum notes telling people not to come to the doctor at all unless they are feeling symptoms is also a wrong approach. He notes there's evidence of some meaningful screening approaches, such as screening obese patients for diabetes risk or patients with a family history of disease.

"It's not a matter of saying to be people don't come into the office," he said. "It's a matter of what should we be doing when that patient comes in."

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