October 19, 2018
Do You Need an Annual Checkup?
Be Well

Do You Need an Annual Checkup?

by John Swartzberg, M.D.  

When seemingly healthy people ask me if they should have an annual physical, I am torn about what to advise. I generally say yes, but the checkup needn't be every year and shouldn't be the standardized, one-size-fits-all "complete physical exam" of yesteryear. I also admit to them, usually to their surprise, that there's little or no research showing that such exams actually prolong lives.

It's logical to think that comprehensive checkups would be bene­ficial, since they can catch problems early on, when they're more likely to be successfully treated. That's why many doctors favor them and why an estimated 45 million Americans have one every year or so. Keep in mind, I'm talking about routine checkups for healthy peo­ple, not office visits to evaluate symptoms or complaints, to manage chronic medical conditions, or to specifically get screening tests.

My 30 years in medical practice suggest to me that such routine checkups helped prolong or at least improve the lives of some of my patients and almost certainly saved one of them: On a routine physical exam of an older man, I felt a large abdominal aortic aneurysm that was on the verge of rupturing; he had it surgically repaired the next day.

That is anecdotal evidence, of course, and I believe strongly in evi­dence-based medicine. So I take seriously several analyses, notably a 2012 Cochrane Collaboration review of 14 studies, which found that rou­tine annual exams do not reduce mortality rates or disability. In fact, the analyses suggest that any benefits the exams may have in the general population would be outweighed by the risk of false alarms, anxiety, overdiagnosis, and overtreatment of findings that would never become life-threatening. Most influential medical groups (including the U.S. Pre­ventive Services Task Force, the American Medical Association, and their Canadian counterparts) have long advised against routine comprehensive exams, as opposed to age-appropriate preventive services. In no other country are routine medical exams as commonly done as in the U.S.

Even so, I think the existing research on routine checkups, which looked mostly at data from 10 to 50 years ago, doesn't capture all the potential benefits of more flexible, personalized health assessments. These visits allow for the evaluation of risk factors, discussion of health habits (relating to tobacco, alcohol, diet, and obesity), and implemen­tation of screening tests and vaccinations. They should also help you forge a medical partnership with your health care provider. The con­tent and frequency of the checkup should be tailored to your age, sex, health risks, and preferences.

There's nothing magical about having checkups every 365 days, and the exams needn't be head-to-toe. For healthy young adults and middle-aged people, every two to five years is fine. Women may need more frequent evaluations for gynecological screening (sometimes called "well-woman" visits). For older people, most of whom have hypertension or other chronic conditions and take medication for them, annual or even more frequent exams are appropriate.

Bottom line: Patients and doctors (or other health care providers) need to get to know each other and develop a working relationship over time. This can't be achieved by emails and phone calls or while dealing with a medical emergency. Ideally, the relationship should be nurtured, and periodic face-to-face visits are at least a start. There’s no question in my mind that this leads to better care—and better outcomes.