Do I Really Need an Annual Physical Exam?
June 7th, 2012There has been recent debate about the necessity of annual physical exams. In the New York Times article titled “Let’s Not Get Physicals” the author, Elisabeth Rosenthal gives the case for people not to get physical exams. I both agree and disagree with her view. Who is getting physicals yearly? I can tell you from experience, it is generally a small percentage of people who have insurance and stable jobs. Many underinsured/underserved people have an extremely difficult time to get access to medical care in their neighborhoods, not to mention have time to do an annual physical. By sending the message that we are doing too much is neglecting the fact that for every person we do “too much” we have a whole lot more for whom we are doing nothing.
An annual physical is extremely important in a population that is over 60% overweight or obese, and a rapidly aging population. Are we supposed to wait until they develop complications of diabetes or have a heart attack to address their needs? In my years of practice, I have seen a large number of patients who came in for annual physicals with absolutely no complaints, whom I later diagnosed with pre-diabetes, true diabetes, high blood pressure, and high cholesterol. There is no doubt that early treatment and detection of these illnesses improves outcomes, and for many medical illnesses there are no symptoms in the early stages. The most clear example of this is hypertension, which is nicknamed “The Silent Killer” as there are few symptoms until it results in a stroke or heart attack.
I do agree with Ms. Rosenthal that not everyone needs tests like an EKG. There is no official guideline from any medical society that states everyone should get an EKG. In my practice, I only do EKG in the setting of hypertension, chest pain, slow or fast heartrate, or if someone is getting a pre-op evaluation. There may be physicians who are getting EKG’s on everyone, but those are the exception and not the rule. Perhaps they need to be educated about what is the standard of care, or in some cases to not get EKG’s just because it is requested by the patient. In all honesty, I can see how many doctors would find it easier to just order the tests a patient requests than taking the time to explain the actual usefulness, risk, and harm of testing. An EKG may take all of about 5 minutes and can be done by a nurse.
Annual physical exams build a relationship with your Primary Care Provider (General Practioner, Physician Assistant, Nurse Practioner, Gynecologist). Why would anyone want to wait until they face a catastrophic event, like developing pneumonia or diabetes, to begin a relationship to a health care provider/system that is totally unfamilar? What if you don’t get along with that particular health care provider? I believe people need to find a provider with whom they feel comfortable talking about all issues, including personal issues related to sexual health.
By establishing a primary care provider-patient relationship, you are creating a friendship with someone who will be there when problems arise. As I mentioned in a Q&A post, it’s like having an accountant when your taxes get audited. You never want to be audited by the IRS and have to look for a CPA who may not know the years of financial information that you have accumulated. I urge everyone to continue to get annual physicals.
