Monday, April 13, 2015

I trust my doctor

It's seems that there is almost an annual debate on the value of annual physicals. Here's the latest article from Medscape and Kaiser Health News:  "Ritual, Not Science, Keeps the Annual Physical Alive." Excerpts:

92 percent of Americans say it is important to get an annual head-to-toe physical exam . . . and 62 percent of those polled said they went to the doctor every year for their exam.

But the evidence is not on their side. "I would argue that we should move forward with the elimination of the annual physical," says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.

Mehrotra says patients should really only go to the doctor if something is wrong, 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 back to the 1980s just don't support it.

I raised this issue last year with my primary care physician (another faculty member at HMS), and she--one of the more quantitatively astute physicians I know--and one who is compulsive about helping me avoid unnecessary tests--scoffed, saying, "Of course I am going to see you every year."

I know my various posts on this blog have strongly advocated the use of evidence based medicine.  It's all right if you want to call me illogical or inconsistent, but when it comes to this matter, I trust my doctor.


Dwight said...

From Facebook:

Had to think about this one. For me the annual physical makes me think about my health, review the good and the bad things I do, and forces me to address any thing that might be causing me any concern. It is also a check on my blood pressure and diabetes risk.

Vanessa said...

From Facebook:

With the use of Telehealth and mobile health devices, the physical may become obsolete.

Brad F said...

If you are 50+, the likelihood of having a medical condition requiring some kind of follow up, likely yearly, is at least moderate. That probability will increase as one approaches 60, etc. Add prevention--counseling on BMI at a minimum--and most folks could justify a PCP trip every year. The visit is going to get booked--its just a matter of how you want to label it.

The question focuses on the young. Or young-ish. I would refocus the question.

Paul Levy said...


The Medical Contrarian said...

There is confusion regarding the language here. Is it valuable to have an ongoing relationship with a physician (or other health care professionaL)? Likely yes is the answer. How one accomplishes maintaining that relationship now is to have an annual visit.

How that is monetized for the doctor is to incorporate a physical exam into that encounter. As it turns out that exam (test) appears to yield almost no useful information, but a physician's ability to collect a fee to support their practice is completely linked to undertaking what may be a useless ritual.

One can collect important information regarding health care using a host of other tools and approaches and maintain a functional relationship between patient and doctor. However, none of these can be monetized readily.

beverly said...

I suggest that some of your trust in your doctor may emanate from your insurance company's coverage of this visit. After paying $250 for a recommended 'yearly checkup" (to be fair, including 3 vaccinations) for my healthy 16 month old dog last week, which included a cursory physical examination and a 45 minute wait, I choose otherwise, until the vaccinations are due again......

Anonymous said...

This evidence-based argument fails because the benefit gained from the yearly physical exam is essentially too difficult to measure. The goals are so diffuse that they could never be completely specified. "Evidence based" has limits which the scientific types with, as we used to say, pencil thin stools, have difficulty fathoming.

Theresa Willett said...

I agree with Mr. Levy and disagree that this is a useless ritual. My perspective as a doctor is perhaps biased by my patients (babies, kids and teens), but I find I miss the ritual for myself.
I am a patient with chronic issues too, and I find a visit where my PCP does not lay hands on me to be somewhat unsatisfying, as though she is not really trying to assess my health. Interestingly, she works for Kaiser, where some of these reports originate. I have wondered if some of this is a sort of "professional courtesy," as I find a lot of docs I see ask me what I think and want without going through an actual exam. It is more likely a symptom of an increasingly depersonalized system swathed in the cloak of personalized care.

To me, as patient and provider, the laying on of hands and quite listening are, together, the healing art of medicine.
Avoiding a regular visit makes me think of "Don't Ask, Don't Tell." That is not what I want out of healthcare from either side of the stethoscope.