SOURCE: Mehrotra A, Prochazka A. Improving value in health care -- against the annual physical. N Engl J Med 2015;373;16:1485-1487.
Commentary that should have led us away from participating in the annual physical has been in front of us for more than 35 years. In 1979, a Canadian task force suggested that the practice of the annual physical, quite simply, be abandoned. Echoing this sentiment, the Choosing Wisely campaign (2013) voted thumbs down to annual preventive examinations in otherwise asymptomatic individuals.
Jane and John Q. Public, however, seem determined to keep the annual physical alive. Approximately one-third of adults sign up for an annual physical each year in the United States, with no sign of abatement over the last 8 years. As clinician-scientists, we must somehow evolve into one of two primary camps. First, embrace what expert reviewers have concluded based on evaluation of outcomes data — that the annual physical does not improve outcomes and expends billions of dollars that otherwise could be spent for greater benefit — and eschew further endorsement of the annual physical. Or second, admit that the annual physical (though perhaps lacking merit on the basis of measurably improved health outcomes) provides fertile ground for germination of difficult-to-quantify elements, such as improved clinician-patient relationships, while acknowledging the recognized outcome limitations.
Mehrotra and Prochazka go so far as to suggest that if the fundamental benefit of the annual physical is relationship building, then we might consider establishing contact visits with the specific agenda of relationship building, rather than anticipating relationship growth as a “sidestream benefit.” To date, the annual physical has shown minimal, if any, benefit and potential for harm. The busy clinical setting has little room for spending time frivolously. Each of us will have to balance the absence of concrete benefits from the annual physical with the rewards measured by ourselves and our patients, accrued by the acutely well patients seeking the reassurance of the annual physical.
To date, the annual physical has shown minimal, if any, benefit and potential for harm.
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