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January 16, 2015

Zeke Emanuel: The annual exam is worthless. You should skip it.

Daily Briefing

Writing in the New York Times this month, University of Pennsylvania bioethicist Zeke Emanuel explains why the 45 million Americans who get yearly general checkups should skip the practice this year.

Although many Americans get yearly general checkups, the United States Preventive Services Task Force (USPSTF) has never issued a recommendation urging people to do so, Emanuel notes. In fact, the annual physical, otherwise known as the "human equivalent of a 15,000-mile checkup and fluid change," is "basically worthless," Emanuel writes.

Study challenges the value of annual physicals

In 2012, the Cochrane Collaboration analyzed 14 trials that followed a total of more than 182,000 participants for a median nine years. The international group of medical researchers then reviewed the data to determine the benefits of routine general health checkups.

They found that annual physicals—Canadian guidelines have recommended against them since 1979—did not reduce mortality rates overall or for particular causes of death, such as cancer of cardiovascular disease.

Why checkups are 'worthless'

One of Emanuel's arguments against the exam is that checkups do little to address chronic conditions, unintentional injuries, and suicides—some of the leading causes of death in the United States.

He also argues that screening generally healthy people for preventive reasons is ineffective, and healthy patients who get an exam sometimes experience compilations or pain from follow-up tests.

Emanuel says ditching the checkup would save physicians hours of exam time, which they could dedicate to patients with medical conditions, "who really do have a medical problem, helping to ensure there is no doctor shortage as more Americans get health insurance."

So why do we insist on keeping them?

According to Emanuel, part of the reason we want to continue yearly checkups is to "reaffirm the physician-patient relationship even if there is no specific complaint." Moreover, it is a habit that has been engrained in many of us since birth. Emanuel writes, "It's hard to change something that's been recommended by physicians and medical organizations for more than 100 years."

In addition, he says, "almost everyone thinks they know someone whose annual exam detected a minor symptom that led to early diagnosis and treatment of cancer, or some similar lifesaving story," which makes people afraid to go without one.

Some reject Emanuel's idea

Responding to Emanuel's column, Modern Healthcare's Harris Meyer writes, "People are not statistics," quoting conservative blogger Wesley Smith. Meyer points out that he actually does know someone—his wife—whose life may have been saved by a regular exam.

In addition, he writes that many people make appointments for physicians because of "practical reasons," such as refilling prescriptions in person so the doctors can see how the medication is working and if there are any side effects (Emanuel, New York Times, 1/8; Meyer, "Vital Signs," Modern Healthcare, 1/14 [subscription required] . 

The takeaway: Zeke Emanuel makes the case against annual physical, saying it does little to improve the health of those who get them.

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