Do you need a physical?

adutlikeThe short answer is that you probably don’t need an annual physical.

Dr. Ezekiel J. Emanuel is an oncologist and a vice provost at the University of Pennsylvania. His article in the NYT called “Skip Your Annual Physical” was really interesting. Read the whole thing if you’re keen, but if not, I’ve shortened it below a bit by leaving out some citations and minor bits.

Around 45 million Americans are likely to have a routine physical this year. There’s a problem: From a health perspective, the annual physical exam is basically worthless.

In 2012, medical researchers analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years evaluating the benefits of  doctors visits for general health and not prompted by any particular symptom or complaint.

The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of the exams from 1963 to 1999 show annual physicals didn’t reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions.

This lack of evidence is the main reason an independent group of experts making evidence-based recommendations about the use of preventive services — doesn’t have a recommendation on annual health checkups. The Canadian guidelines have recommended against these exams since 1979.

It’s hard to change something that’s been recommended for more than 100 years. Plus, there’s skepticism about the research. Almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story.

One explanation for the annual exam’s ineffectiveness in reducing the death rate is that it does little to avert death or disability from acute problems. Injuries and suicides are, respectively, the fourth and 10th leading causes of death among Americans. And it does little for chronic conditions such as Alzheimer’s, the fifth leading cause of death among older people.

Screening healthy people who have no complaints isn’t an effective way to improve people’s health. Screen thousands of people and maybe you’ll find tens whose exams suggest they might have a disease. And then upon further tests, it’s really only a few individuals who have something. And of those, maybe one or two actually gain a health benefit from an early diagnosis.

Some others may have discovered a disease, but one that either would never have become clinically evident and dangerous, or one that is already too advanced to treat effectively. For instance, early detection of most thyroid cancers leads to surgery, but in many cases those cancers wouldn’t have caused serious problems, much less death. Conversely, if an annual exam uncovers esophageal or pancreatic cancer, the early diagnosis might extend the time they know they have cancer but is unlikely to extend their lives.

Some healthy patients undergoing an exam sometimes end up with complications and pain from further screening or confirmatory tests.

So get flu shots, a colonoscopy every 10 years, eat a balanced diet, and get regular exercise. These are proven to reduce morbidity and mortality. I won’t be getting an annual exam, freeing up countless hours of doctors’ time for medical problems and helping prevent a doctor shortage as more Americans get health insurance.