Medical experts divide on physicals
Published June 28, 2005
CHICAGO - Many adults think a yearly checkup is just part of staying healthy, and a new survey shows doctors do, too.
But a panel of experts says there's no evidence annual physicals for healthy people are useful.
In a survey published Monday, 65 percent of primary care doctors said such checkups are necessary and nearly 9 out of 10 said they perform the exams.
The survey, conducted in 2002 by Dr. Allan Prochazka and colleagues at the University of Colorado Health Sciences Center, appears in the Archives of Internal Medicine . It renews a debate over annual physicals that dates back at least nine years. That's when the U.S. Preventive Services Task Force declared there is insufficient evidence of any benefit from many of the tests often given with yearly checkups.
What an annual physical includes varies widely from doctor to doctor.
Almost all the doctors surveyed said it should include height, weight and blood pressure. Most also said it should include a Pap smear for women, and more than 40 percent said they would include mammograms when appropriate, tests of cholesterol and blood sugar, and a urinalysis.
The task force is a respected nongovernmental panel of researchers commissioned by Congress to develop evidence-based recommendations for medical care. It doesn't recommend for or against annual physicals, and neither does the American Medical Association.
In the survey, many among the 783 doctors queried said routine exams should include tests that the task force says haven't been proven to prevent disease in healthy adults, including urine tests, blood-sugar tests for diabetes and thyroid tests.
The most frequently recommended tests included complete blood counts, or CBCs, which check for conditions including anemia. Nearly 40 percent of doctors said those tests should be part of routine physicals, despite studies showing "that there is very little yield" from routine CBC testing, the researchers said.
Dr. Ned Calonge, the Preventive Services Task Force chairman, said he's "bothered by the fact that so many people were ordering tests of unknown benefit" and even potential harm if they lead to unnecessary invasive followup testing.
The study says routine physicals have been popular since the early 1920s, when an article in the Journal of the American Medical Association discussed their value in finding disease in apparently healthy people.
Technology and the development of screening exams, such as Pap tests for cervical cancer, mammograms and colon cancer tests, reinforced the idea that yearly exams are needed. Many medical groups recommend that these tests be done routinely, though not necessarily every year.
Pap tests generally are recommended at least every three years for women of childbearing age, or every year if a recent test had abnormal results. Colon cancer screening - at intervals up to 10 years apart - and mammograms at least every two years are not recommended until middle age.
In St. Petersburg, Dr. Arnold Ramirez knows that studies have shown annual visits sometimes have little medical benefit. But he still believes in them.
"I do them to build relationships with my patients," Ramirez said. "It's one of the most important things I can do: develop relationships with my patients, so we can work together on improving their health."
Patients who get to know their doctors when they are healthy are more likely to confide in them when they develop symptoms that bother them, even if they seem embarrassing or scary, said Ramirez, a family practitioner with Bayfront Family Health Center.
Annual visits also allow some time to talk about preventive medicine, said Dr. John Carthy, a Tampa doctor who has been a family practitioner for more than 30 years.
"Frequently it's a screening for cholesterol, counseling for weight control, blood pressure and other risk factors," Carthy said. "Most people like to hear that from the doctor - to say, "You really should lose weight and exercise.' It's a motivational thing."
Many health insurers pay for some periodic preventive screening but not annual physicals. An earlier study by the researchers who surveyed the doctors found that about two-thirds of consumers believe an annual physical is necessary, but only one-third would want one if they had to pay for it.
--Times staff writer Lisa Greene contributed to this report.
[Last modified June 28, 2005, 01:47:08]
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