Annual Physical Exam: Unneeded Expense?

An annual physical exam is a tradition for many U.S.
adults, but it is not always necessary, according to a new study.

"I'm not advocating we should get rid of these visits," says
researcher Ateev Mehrotra, MD, MPH, assistant professor of medicine at the
University of Pittsburgh School of Medicine and a policy analyst at RAND
Corp.

Rather, the preventive services and tests ordered at these exams that are
actually necessary often can be received -- and often already are -- at other
visits and times, says Mehrotra. The study is published in the Sept. 24 issue
of the Archives of Internal Medicine.

Using two national surveys, Mehrotra and his colleagues analyzed 8,413
doctor visits for preventive health exams (annual physicals) and preventive
gynecological exams -- which women schedule to get Pap tests and pelvic exams.
The doctor visits too place from Jan. 1, 2002, to Dec. 31, 2004.

Among the findings:

• About 44.4 million adults, or nearly 21% of the population, get a
  preventive physical exam annually.


• About 19.4 million women, or about 18% of adult women, get a preventive
  gynecological exam annually.B


• Together, these account for 8% of all doctors' office visits. If every U.S.
  adult got an annual physical, the U.S. health care system would need to provide
  up to 145 million additional visits annually, the researchers estimate.


• Most preventive care, about 80%, was received outside the preventive exams,
  when the patient saw the doctor for other reasons.


• The cost of providing both types of routine exams was about $7.8 billion --
  almost the amount spent for breast cancer care in the U.S. in 2004.


• More than a third of the annual physicals in the study included testing
  such as complete blood cell counts or urinalysis, which Mehrotra says are not
  proven to improve patient outcomes when performed routinely and so may be
  unneeded.B Complete blood cell counts and urinalysis cost about $192
  million a year in the study.


• The annual physicals and preventive gynecological exams, however, were the
  most common avenue for getting certain crucial tests such as mammograms and Pap
  tests.


• The number of adults getting the annual physicals varied by region,
  reflecting differing beliefs and practices. "Those in the Northeast have a
  60% increased chance of getting a physical compared to those on the West
  Coast," Mehrotra tells WebMD.

(Do you get an annual
physical? Why or why not? Talk with others on WebMD's Health CafC) message
board.)

Annual Physical Exams: The Ongoing Debate

The discussion about whether an adult needs an annual physical has been
ongoing for nearly a century, Mehrotra tells WebMD. Currently, no major North
American health-related organizations recommend the routine annual exams, he
says.

Still, many patients as well as many doctors believe the annual visits are a
medical necessity. "The vast majority of people think they are being good
patients if they go in to see their doctor every year," says Mehrotra.
"Most doctors actually believe the same thing."

Yet, the value of the exams has not been established in studies, he
says.

"We need to figure it out," Mehrotra says. "Do people need to
come in for a special visit? Can't we do a lot of these services at other
times, without the need for a [special] visit?"

The new study, he says, suggests that crucial preventive services can easily
be received during other visits, and often are.

Second Opinion

The study provides some valuable information, says Douglas K. Owens, MD,
senior investigator, VA Palo Alto Healthcare System and professor of medicine
at Stanford University. "The researchers are saying these [annual
physicals] are common, often provide preventive services, but that many
preventive services are provided at other visits"

"It is important to understand what these exams accomplish," he
says, "and that there are other ways to accomplish the same thing that
might be more efficient and cost-effective."

Owens chairs a subcommittee of the American College of Physicians that
develops guidelines about treatment and care but says he is giving his opinion,
not that of the college.B The ACP has no official guideline about the
annual physical, he says.

Some advocates of the annual physicals see the yearly exam, Owens points
out, as a good way to build the patient-doctor relationship. Yet that
relationship can be worked on, others say, in any doctor office visit, not just
the traditional annual physical visit.

Take-Home Points on Annual Physicals

What's the message for patients? "The important thing for consumers is,
there are preventive services important to get," Owens says. "If they
are getting them as part of their routine care, that is great. If not, a
periodic health exam may be a good avenue to get them."

"Have a conversation [with your doctor]," Mehrotra suggests. "If
your doctor tells you [that] you don't need to come in for an annual physical
or don't need some of these tests, he's not [just] trying to save money.
Patients should realize there is a lot of controversy about the value of
physicals and they should have a conversation with their doctor about
it."

Patients should also realize, he says, that the preventive services they
absolutely need can be received outside the traditional annual physical
exam.

By Kathleen Doheny
Reviewed by Louise Chang
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