The Future of the Physical
Peter L. Slavin and David F. Torchiana examine the future of the physical exam.
Responsible people take routine preventive maintenance seriously. They replace the batteries in their smoke alarm every year. They change the oil in their car regularly. They visit the dentist every six months. And each year they head to the doctor’s office for a physical. Taking sensible precautions, after all, should reduce risk and help prevent serious problems—maybe even disasters—from occurring later.
But in recent years, mounting economic pressures have prompted a long, hard look at the value of some time-honored conventions—including the annual physical. With the cost of routine check-ups in this country at nearly $8 billion a year, it’s no wonder that the return on investment of this widely accepted health care ritual is being questioned.
In this issue of Proto we examine the exam. We talk with experts who offer compelling arguments about the many benefits of an annual face-to-face visit with a primary care physician. We also hear from those who have carefully studied the issue and demonstrated that such exams are costly and don’t actually do much to prevent disease or help us live longer.
While most patients and doctors still like the idea of an annual physical exam, no major medical group now endorses this concept. With the increasing focus on curbing health costs, it seems reasonable to ask whether healthy adults who eat sensibly, exercise and faithfully undergo recommended screenings really need a once-a-year, 20-minute, hands-on visit with their physicians. Would two years be a better interval? Three years? Five years? Never?
Experts do agree on the value of particular tests and screenings—checks of weight and blood pressure, mammograms, Pap smears, colonoscopies. The annual check-up provides a good opportunity for doctors to do these tests or make sure a patient has scheduled them. A yearly visit also has less tangible, less measurable benefits, including the opportunity to develop and nurture the relationship between doctor and patient, building a sense of comfort and trust that can become especially valuable during a serious illness. And the peace of mind that comes from getting a clean bill of health should not be underestimated. The yearly physical also lets patients get answers about nagging issues that may not merit a separate visit—that patch of scaly skin, recurring headaches, creaky knees, a bump in the scalp, feeling overwhelmed or overstressed.
Delivering great primary care is an art—highly nuanced and personal. Every patient is unique, with different needs, issues and concerns, and what is right for one may not work for another. In the end, whether a person undergoes a physical exam annually, occasionally or not at all shouldn’t depend on the broad conclusions of academic research. Rather, it is best decided by each patient and each doctor together, as a team.
|Peter L. Slavin, M.D.
Massachusetts General Hospital
|David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians