Should we get physicals? Physicals

Study questions the need for physicals, which it deems expensive and inefficient for illness prevention

Tuesday, April 7th, 2009

Dreading your next visit to the doctor? Lucky for you, physicians say annual checkups may not be necessary.

A study published at the University of Pittsburgh questions the necessity of physicals, noting they are costly and do not always prevent illness.

According to research, 80 per cent of preventative care occurs outside of physical exams.

Physicals have even been called inefficient and non-specific by the Canadian Task Force on the Periodic Health Examination.

Dr. Ateev Mehrotra, lead author of the study and assistant professor at the University of Pittsburgh School of Medicine, suggested a new system that would allow patients to directly seek the tests they require, rather than going through their physicians.

“Why do women need to go see their doctor to go get a mammogram ordered?” Dr. Mehrotra questioned.

Dr. Albert Annen, a London family physician, insisted annual examinations are important.

“You do identify things.”

The question is: are they worth it? Physicals in the US cost an estimated $116 per person, totaling $8 billion US.

Doctors are also questioning the actual specifics of a physical. While some things like Pap smears and cholesterol tests are routine, other parts of the examination are left to the doctor’s discretion.

“We saw that some doctors were ordering tests, some were not; some were offering counselling and some were not,” Dr. Mehrotra said.

Another issue is the possibility of doing more harm than good in a physical. Sometimes tests result in a false positive, which leads to further invasive testing.

“It’s easy to think, ‘Oh its just a little inexpensive screening test,’” Dr. Mehrota said. “But there can be a lot of unnecessary harm.”

Other tests, such as X-rays, pose immediate threats such as radiation.

Dr. John Feightner, former chair of the Canadian Task Force on Preventive Health Care, argued, “What the evidence [of medical tests] suggests, outweighs [its possible] harms.”

He said doctors should use more faithful tests in order to avoid false positives.

Dr. Annen found a balance. He recommends patients base the frequency of visits on their age and risk factors.

“I wouldn’t do annual checkups on someone in their twenties,” he said.

For the average 40-year-old, Dr. Annen recommends a check up every two or three years, while a 50-year-old should be examined annually.

Doctors are also learning to use the yearly check up as a chance to advise their patients on lifestyle choices and counsel them on other health concerns.

Dr. Feightner said this is an improvement on the routine top-down examination some doctors use for patients, regardless of age and sex.

Dr. Mehrota said: “We need consensus on whether we should have these or not because it’s a lot of time and a lot of visits.”

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