How to quantify the value of annual physicals?

As the days of Marcus Welby-style healthcare fade further into the past, so too should the 100-year-old practice of conducting the annual physical, wrote oncologist and health policy expert Ezekiel Emanuel, M.D., Ph.D., in a column for the New York Times. The argument against this yearly visit for most patients is not new, and is based on data that shows checkups don't help patients live any longer.

A leading reason physicians and patients hang on to the exam, according to Emanuel, is the idea that checkups facilitate lifesaving early detection of disease. But even in the rare case a condition is caught during a checkup, he stated, it's unlikely to affect that patient's mortality. "For instance, early detection of most thyroid cancers leads to surgery, but in many cases those cancers would not have caused serious problems, much less death," he wrote. "Conversely, for individuals whose annual exams lead to the diagnosis of esophageal or pancreatic cancer, the early diagnosis might extend the time they know they have cancer but is unlikely to extend their lives."

A newer twist on this established debate, however, has to do with cost. While Emanuel and other checkup opponents cite the billions spent on annual exams, screenings and follow-up as wasteful and unnecessary, others, such as concierge practice consultant Wayne Lipton, contend that this investment in the physician-patient relationship pays off in the long run through better managed disease.

"I know from working with hundreds of doctors and hundreds of thousands of patients that having a stronger doctor-patient relationship helps physicians to better understand and manage problems," Lipton wrote in Physicians Practice. "More time together is what is needed to establish that kind of relationship, and often that time is only available during an annual checkup."

It's also worth noting that the Affordable Care Act not only mandates free preventive services for patients, but that greater awareness of services available is also leading ACA-covered patients to book more physicals, FierceHealthPayer reported.

Nonetheless, physicians' response to Emanuel's op-ed piece "has been 90 percent supportive," he told Medscape Medical News. "They've looked at the data and are not convinced by the data [of the annual checkup's value]."

Defenders of the annual physical also spoke with Medscape, and noted the importance of screening for problems such as high blood pressure, domestic violence and psychological distress before they cause acute problems. "Unless patients get regularly checked, by the time they come in, it's a catastrophe," said Peter C. Galier, M.D., a professor at the University of California, Los Angeles, School of Medicine.

To learn more:
- read the column from the New York Times
- see the article from Medscape
- read the post from Physicians Practice