Physician point/counterpoint: The benefit of annual physicals

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In today's world of busy schedules for physicians and patients alike, some have questioned the importance of annual physical exams.

Three physicians debate the topic in a recent issue of The New England Journal of Medicine. While Allan H. Goroll, MD, argues for the benefit of annual physicals, Attev Mehrota, MD, and Allan Prochazka, MD, are not in favor of the appointments.

Here are three points from each side of the debate.

In favor

1. Through annual physicals, patients maintain a relationship with their physician. In the mind of Dr. Goroll, it's unsurprising many are not in favor of annual physicals — they're becoming a "rushed, impersonal and largely bureaucratic exercise." But taking the time to establish a personal, mutual relationship with a patient benefits the patient's health and wellbeing. Dr. Goroll outlines a few primary benefits of a physician-patient relationship, including "enhancements in functional status, patient satisfaction and adherence to medication regimens."

2. Eliminating annual physicals disregards the meaningful effect of the "laying on of hands." Dr. Goroll references "the laying on of hands," which refers to an effect appreciated by healers and recently acknowledged in neurophysiological terms via neuroimaging. Rather than a create systematic, almost robotic type of exam, a kind, gentle physical examination method can build upon the physician-patient relationship and facilitate a therapeutic environment of trust and care. Such a method also has clinical benefits: "From this perspective, the performance of the physician's annual physical examination becomes as much an act of relationship building and continuity as it is a means of searching for clinically significant findings," Dr. Goroll wrote.

3. The annual physical should be improved, not abandoned. Dr. Goroll calls for an annual health review — similar to a medical home model — to replace the annual physical. This technique, which utilizes a team-based approach, utilizes all clinical team members' skills, allowing the physician to spend more time with the patient. As part of the process, the physician would gather and review data on each individual patient. As Dr. Goroll notes, replacing the physical with the health review "represents an opportunity to create new value for both patients and doctors, enabling the latter to serve as physicians rather than merely health care providers."

Against

1. Annual physicals have minimal benefits and potential harms. Dr. Mehrota and Dr. Prochazka reference two studies, which show annual physicals decrease patient worry, but they don't reduce morbidity or mortality. The authors also highlight a riskier claim: Annual physicals "may actually be harmful." The physical exam and various routine tests have low precision and specificity, which may account for false positives in certain patients.

2. Cutting out annual physicals would save time and money. In addition to saving the time of approximately 220 million American adults each year, physicals would save primary care providers' time. One study shows 10 percent of physicians' time is spent on annual physicals — time that could be spent on patients needing more urgent care. In addition, the cost of annual physicals adds up. Over $10 billion a year is spent on physicals in the U.S., which is similar to the annual costs of lung cancer care.

3. Three key steps can be taken to replace the annual physical. Dr. Mehrota and Dr. Prochazka advocate for three new tactics. The first is that new visit could be created for the exclusive purpose of establishing a physician-patient relationship. Second, physicians should make sure their patients' preventive care is up-to-date and recent. Finally, the authors believe health insurers should stop reimbursing for annual physicals.

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