Tag: physical exam

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Merits of Having an Annual Physical Examination

Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)
Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)

Most health conscious adults get a yearly physical examination. Sometimes people wonder whether it is worth going through the process on a yearly basis – especially if you have no health issues.

An article in the Canadian Medical Association Journal (CMAJ November 4, 2014) discusses the pros and cons of such a yearly ritual (The periodic health examination in adults by David Ponka). The main purpose of this yearly ritual is for screening and preventive purposes.

This ritual dates back to at least the industrial revolution, when employers paid for annual check-ups to keep their labour forces healthy, says the CMAJ article. Now the practice has become one of the duties of a family doctor to keep the patients healthy. Interestingly enough, it is not an insured service in all provinces.

The question usually asked by the people who consider this an unnecessary expensive yearly ritual is, “Does it keep the adults healthy?”

The answer to this question is unclear, says the article. Some countries, such as the United Kingdom and Germany, encourage yearly physical examination for otherwise healthy adults aged 40–75 years. The reason being that this group has an increasing burden of lifestyle and chronic diseases that may be amenable to intervention. In Canada, the trend is toward reducing or eliminating the use of such yearly rituals in adults. One way is to disallow coverage by the health insurance plan.

There are some advantages to yearly physical examination for high-risk patients compared to low risk patients. The annual visit to a doctor provides opportunity to perform evidence-based preventive tests, to counsel patients on lifestyle issues, update vaccinations and, importantly, to identify risk factors and diagnoses through updating the patient history, says the article.

There is no scientific evidence to show that the annual physical examination reduces sickness and death in the community. On the contrary the annual ritual may lead to too many blood tests, chest x-rays and ECGs, exposing patients to the risks of investigation, such as false-positive results and over diagnosis.

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. They have a very interesting website. You can Google it. It’s recommendations on periodic health examinations are:

-Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.

-Don’t order screening chest x-rays and ECGs for individuals with no symptoms.

The article says that the value of a regular (not necessarily annual) physical examination may lie in other factors like:

-To assist marginalized groups who would otherwise not attend regularly

-It may also assist in efforts around management of chronic disease and over medication.

What do you think? If you are not sure whether you need an annual physical examination then discuss with your family doctor. Greetings for the holiday season. Be safe and eat less.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Annual Physical Check-up

An apple a day keeps the doctor away? Is prevention better than cure? What about an annual physical examination? Is that the best way to stay healthy? Many people think so.

“The truth is that all of us are, to greater or lesser degrees, prisoners of ritual,” says Dr. Richard Goldbloom, MD, in an editorial in the Canadian Medical Association Journal (CMAJ). We perform these illogical practices to reduce our level of anxiety or, at least, to prevent it from rising.

Dr. Goldbloom is a Professor in the Department of Pediatrics, Dalhousie University, Halifax, NS.

In 1980, the Canadian Task Force on the Periodic Health Examination (now called the Canadian Task Force on Preventive Health Care) recommended that the routine annual physical examination should be discarded in favour of a selective plan for prevention to suite individual requirement.

Many physicians disagree with this recommendation.

Currently, physicians are inundated with clinical practice guidelines that are based on sound scientific evidence. But not many physicians buy into these guidelines as they conflict with the percieved needs and expectations of patients and physicians, Says Dr. Marie-Dominique Beaulieu and others in the same issue of the CMAJ.

Dr. Beaulieu is a Professor of Family Medicine at the University of Montreal, Montreal, Quebec.

The study conducted by Dr. Beaulieu and others, show that the majority of the physicians and patients find the annual check-up beneficial for variety of reasons. One important reason is that check-up permits a more thorough evaluation than regular medical visits. It also builds trust.

The authors say that tests play an important role for patients in their personal preventive routine. Patients considered test results more accurate than the history and physical examination.

Physicians value the history and physical examination much more than test results. Since there are very few truly effective screening tests, physicians feel the downgrading of the annual check-up unacceptable.

A screening test should have some effect on the disease process and offer gain in life expectancy to the majority of the people who under go such tests.

But there are many drawbacks to offering the public preventive therapy. It creates unnecessary anxiety. It exposes the public to procedural complications and the risks of false-positive and false-negative results; and it creates an unhealthy preoccupation with disease among the public.

It has a potential to induce fear.

Over use of diagnostic procedures for screening purposes creates long waiting lists. Thus the patients who would most gain from the test may be deprived of the benefit.

“Another attractive concept has been widely promoted is the belief that if more money were spent on prevention, less would have to be spent on treatment – a concept that, with a few exceptions, does not stand up to close scrutiny,” says Dr. Goldbloom.

For physicians and patients, annual check-up and tests relieve anxiety. To them, this is more important then worrying about clinical practice guidelines. For the preventive medicine experts, the biggest challenge is to bridge the gap between science and ritual.

Dr. Goldbloom says, “… physicians, like patients, are just plain folks after all, enslaved to ritual and tradition, reiterating beliefs and practices that both groups believe, logically or not, have served them well.”

So, don’t forget your apple today!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!