The Case for the Annual Checkup

Annual CheckupIn a Washington Post article in August 2013, writer Brian Palmer makes the case that going to your doctor when you are not ill does more harm than good. He cites the extraordinary amount of time and money wasted by routine annual physical exams and points out that routine annual testing discovers false positive items that lead to further tests, cost and ultimately potential harm.

I suspect Mr. Palmer is a thirty-something year old individual with no chronic health issues, no personal physician and a high information technology IQ which allows him to access, digest and interpret data quickly and accurately so he can self-treat his primarily self-limited illnesses.  Perhaps the relative lack of exposure to severe and chronic illness on a personal level allows one to take a cost effective politically correct stance in a world where no one will actually have a personal physician. You may be part of a constantly changing “team” or go to a corporate drug store’s walk in clinic but you will be treated by some provider who knows you only for that episode and has no desire or incentive to see you until your next health crisis.

The annual exam is designed for the physician to get to know the patient in health. For children it is a benchmarking event to see if they are meeting the physical and emotional growth parameters needed to advance to puberty and adulthood. It is usually scheduled sometime before school starts and within the session vaccinations and immunizations are given to prevent infectious disease, vision is tested to make sure the child can see well enough to compete in a school environment and basic hearing evaluations are done to make sure your child can hear what the teacher is saying. There is little radiology or laboratory testing in this age group

Adolescents still are checked for physical and emotional growth and benchmarks.  They have their vaccinations and immunizations to receive before going off to dormitories for the college years or barracks for the military. As they move toward adult hood, the annual exam provides an opportunity for screening and teaching about sexually transmitted diseases, birth control, adult habits and their consequences.  It is a time to discuss what basic screenings they will need to have as they move towards independent adult status and how frequently.

As adults age they need a doctor. Women of child bearing age usually use their obstetrician gynecologist. If they have particular problems relating to blood pressure control during pregnancy, lipid or glucose metabolism problems during pregnancy, they need an adult doctor and a checkup. The data clearly shows that this subgroup of young women develop heart disease and stroke more frequently than others and have a higher mortality at a younger age unless treated.  Mr. Palmer may find their time away from work and the cost of a history taking session discussing diet , exercise, tobacco and drug and alcohol use, a physical exam including a dilated retinal eye exam, foot exam , fasting blood sugar, lipid profile  and urinalysis looking for urinary proteins to be a waste of time and money. It can, however save a person from losing a limb or their vision or their life at a young age.

The definition of what constitutes an annual exam for purposes of Mr. Palmer’s article needs to be clarified. You can go to the Mayo Clinic and for several thousand dollars receive a top to bottom exam with enough imaging studies to look at your body from the tip of your head to your toe inside and out. This is usually accompanied by a summary consultative session and a written report to take home for your records and review.  An alternative is to make an appointment with your local family physician, general internist or obstetrician and provide a thorough medical and social history and receive a detailed examination of your body without using radiation or imaging studies.  Based on what is discovered or not discovered you then sit down with your doctor and establish a plan for maximizing your health and minimizing your chance of developing illness over the next year. There may be testing suggested but it is generally relatively inexpensive basic laboratory blood and urine testing. These are the sessions where you can discuss appropriate screening tests based on your age, gender, family history, life style, history and physical exam.  It is an opportunity for your physician to get to know you and vice-versa.  Knowing how you look and act and participate in life activities when healthy definitely does give your physician an advantage in realizing when something is different and wrong.

As you age you need a physician to coordinate your care, be your advocate and work with you to establish health care goals that are realistic and attainable. Time intensive but thorough and comprehensive reviews of your prescription medication intake plus over the counter vitamins, minerals and supplement intake saves lives. When you add in advanced age, alcohol, diminished vision, arthritic joints with loss of position sense when transferring weight as you walk, the annual exam becomes a fall prevention session.

Employers, insurers and economists would like us all to be able to travel over the internet to a website, enter our histories, enter our physical attributes and findings based on our untrained opinion and let a computer program plan, evaluate and advise us.  That level of automation and accuracy may someday come. Until then I suggest you do it the old fashioned way by seeing a doctor, giving your health history and getting a thorough and comprehensive physical exam.