Annual Exam — not needed and may be harmful

wellnessexamDON’T GET AN ANNUAL EXAM.  The data are clear — see the recent article in the New England Journal of Medicine and the op-ed in the New York Times — perhaps you missed this counter-intuitive health advice?

aircraftmaintenanceMechanical devices need preventative maintenance.  The aircraft mechanic in the illustration prevents engine failure by checking and replacing parts before they go bad.  He knows the MTBF (mean time between failures) for the various engine components.  You would think this is how the human body works but THAT’S NOT TRUE.  You don’t take out an appendix like a spark plug just because they sometimes go bad — you fix it only when needed because surgery hurts and has complications.

One third of the US adult population get annual physical exams and primary care doctors spend 10% of office visits doing those exams.  Sound research shows the annual physical is not needed and worse yet, may be harmful because of false positives (tests that say something is wrong but later are proven wrong).  It’s the very essence of a false positive — an abnormal test in a healthy person!  You know where that leads:  “we need to do some additional tests or a biopsy” — just hope it’s not a brain biopsy.

The US healthcare system needs the wasted 10% of primary care time elsewhere.   It’s totally crazy — doctors doing unnecessary annual exams that clog up the appointment calendar and make it hard for people with actual  problems to get an appointment.  And, a large number of people have health problems who don’t see health care providers when they should (but that’s another story)!

Doctors like to do annual physicals — it’s nice to visit with patients and not have to make any hard decisions.  And, they make a lot of money doing the exams under the guise of “maintaining a relationship”.  But, the exams are not needed.

A proactive patient would make health care appointments as needed for the following:

  1. Annual flu shot
  2. Tetanus vaccination every 10 years.
  3. Cholesterol test every 5 years
  4. For women over 40 a pap smear every 3 years and a mammogram every 2 years.

Do you really need to have a health care provider tell you the following things, or is this list enough?

  1. DO keep weight in normal range (BMI below 25)
  2. DO walk 30 minutes every day
  3. DO wear seat belts
  4. Don’t use drugs or alcohol
  5. Don’t smoke
  6. DO Check blood pressure every year (automated checks are just fine)
  7. DO see a health care provider if you have a health problem.

Keep in mind this discussion is about an exam for nothing in particular — just a “check-up” — which you don’t need.  On the other hand, a patient needs visits with a health care provider to treat and monitor abnormal conditions.  You need routine visits to adjust blood pressure medications, to treat diabetes, to treat acne and to evaluate arthritis.






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