Do Routine Physical Examinations Save Lives?

Lasse T. Krogboll, of the Cochrane Nordic Center in Copenhagen, Denmark and coauthors published an article in the online edition of the Database of Systematic Reviews that suggests that routine examinations do not save lives.  The material was reviewed in the University of Pennsylvania Medical Center online periodical Medpage Today and was critiqued by a physician at the Harvard Medical School.

The study was a systematic review of 16 clinical trials involving 183,000 patients followed for a median of 9 years. The review concluded the risk of mortality in individuals who had regular checkups, compared to those who did not, was not statistically different.  “General health checkups did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased.”  “With the large number of participants and deaths included, the long follow-up periods used and, considering that cardiovascular and cancer mortality was not reduced, general health checkups are unlikely to be beneficial.”

In commenting upon the study, Doris F. Zaleznik, MD, Associate Clinical Professor of Medicine at Harvard Medical School and Dorothy Caputo, MA BSN RN admitted that “most of the trials were old, which makes the results less applicable to today’s settings because the treatments used for conditions and risk factors have changed.”  They additionally noted that one reason for the lack of efficacy of routine general checkups might be that “primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons.” They additionally suspect that “those at high risk of developing disease may not attend general and health checks when invited.”

The release of this online study was dramatically promoted. One must embrace evidence based data but keep in mind that there is a strong push in the USA to reduce health care spending overall as a percentage of the gross national product.  Anything that seems to say, “Do not seek evaluation “seems to garner more attention than it is due these days.

The study did not clearly define what a general health checkup includes.  I still believe that finding a good doctor and seeing that doctor annually for a benchmarking session to review your health wellness and habits by performing a thorough history and physical examination and, comparing your habits and findings to current recommended guidelines and treatments, is a worthwhile endeavor.  The general health exam does not need to include numerous and expensive laboratory and imaging studies unless the history and examination suggest the need to pursue those options.

As medical science identifies genetic and molecular mechanisms of disease, I am sure the next long-term Cochrane Review will show the efficacy of these annual general physical examination sessions in limiting disease and extending life.