June 28, 2005
Tuesday

Professional guidelines don't endorse them, but a new survey of family doctors shows that most still see value in adults getting an annual checkup even if the patients have no specific symptoms.

The survey, published Monday in the Archives of Internal Medicine, showed that 65 percent of respondents believe an annual physical examination is necessary, and 88 percent said they do them for at least some patients.

As far as "evidence-based medicine" is concerned, giving an annual physical exam to a healthy adult with no particular risk factors or symptoms is a waste of resources. Yet a new survey of front-line doctors shows that almost 9 out of 10 still perform the exams, and 65 percent said they think they're necessary; patients felt that way by the same margin in an earlier survey. For many doctors, it's the only way they can take time to get to know their patients, the survey suggests.

The study, done in 2002, was based on responses of a random sample of 763 primary-care doctors in and around Boston, Denver and San Diego. Dr. Allan Prochazka and colleagues at the University of Colorado Health Sciences Center and the Denver Veterans Affairs Medical Center led the research.

The doctors' policies go further than screening guidelines from both the American Medical Association and the U.S. Preventive Services Task Force, a non-government panel of experts set up by Congress to make evidence-based recommendations for medical tests and examinations.

The task force declared nearly a decade ago that there's not enough evidence of benefit from yearly checkups to justify recommending them.

The researchers said that guidelines for screening, including blood and urine tests, generally call only for the tests to be done based on a patient's personal and family history and what other risk factors for a disease they might have.

But one of the concerns about doing too many tests on those with no apparent problem is that a false-positive result may needlessly worry patients and require more tests to determine that there is, in fact, no disease.

Yet many doctors surveyed said they routinely ordered those tests as part of routine physicals. "Surprisingly, in view of the current evidence, 74 percent thought that an annual physical examination improved the detection of (illness without symptoms)," the authors said.

Part of the reason so many doctors still do checkups is that they may feel patients expect them _ 78 percent of respondents said they believed most patients expect screening exams.

While most health insurance plans pay for some screening tests based on a patient's age or risk factors, most don't pay for yearly checkups for adults. Yet an earlier survey by the same researchers found that two-thirds of consumers believe an annual physical is necessary, but only about a third would want one if they had to pay for it.

Perhaps more telling, though, is that 94 percent of doctors surveyed felt that doing an annual physical "improved the physician-patient relationship and provided valuable time for counseling on preventive health behaviors" _ time that many doctors don't feel they're able to take on other office visits when patients come in with a specific complaint.

In an accompanying editorial, Dr. Patrick O'Malley of the Uniformed Services University of the Health Sciences in Bethesda, Md., and Philip Greenland, editor of the journal, noted that perhaps patients and physicians "value something about what the annual physical provides that the evidence has failed to address ...

"Meaningful relationships take time, and the current culture of health care does not explicitly value time spent on developing relationships between patients and physicians ... Perhaps the annual physical has become the forum to serve that purpose."

On the Net:

www.archinternmed.org

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