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The annual physical exam — a medical ritual that seemed to be going the way of the house call —is making a comeback with an individualized twist, according to Utah physicians.
"There are a lot of people who felt that if you have a healthy individual, the resources and time you are expending aren't worth what you can find out from a general physical," says Scott Hansen, medical director at LDS Hospital and an expert in preventive medicine. "Some people look at it and say it's a waste of money."
Several studies in the past decade indicated that although patients thought it was a good idea, the old-fashioned annual physical was mostly a waste of limited health-care dollars. Instead, the American Medical Association recommended individualizing medical checkups to review a patient's family medical history and risk factors.
Many skeptical physicians believe that a routine rapping on the knees with a rubber hammer and putting a cold stethoscope on someone's chest is unlikely to turn up a serious but asymptomatic medical condition lurking below.
But Hansen and other preventive-care physicians argue that the traditional face-to-face discussion that takes place during a routine checkup can set the stage for preventive health care and, if needed, more focused testing that actually will reduce medical costs. Most health-care spending is for medical problems rooted in a handful of underlying causes that can be mitigated through lifestyle choices, including nutrition, exercise, stress, sleep, weight and avoiding harmful substances such as tobacco.
"The annual examination, depending on the age group, is a time when you discuss preventive care," says Tom Miller, chief medical officer for University of Utah Health Care and an associate professor of internal medicine in the U.'s medical school. "You can use the annual visit the same way you meet with your accountant about your taxes or household finances. The annual checkup is a way to go over the patient's history and have any needed screening or tests done in a coordinated fashion and scheduled in a way to get it all taken care of. Your doctor can give you a knowledge base to help you navigate through preventative strategies — what are the things that will definitely make a difference in your future."
As for the cost effectiveness of such a consultation, Hansen says that catching medical issues early saves significant health-care spending down the road. "The annual physical examination is valuable because a doctor can sit down and plan with, train and coach the individual in making lifestyle changes that will affect their future health."
Many physicians conduct this kind of preventive counseling when a patient visits for another reason such as a cold or injury, Miller says. "The doctor can go over routine things with you — tetanus shots, cholesterol and diabetes testing, colonoscopies and family history of disease."
But Hansen and Miller point out that a trip to the doctor for an acute issue — the flu or a physical injury — is probably not the best time to piggyback a discussion of preventive health care.
Older people, especially if they have health issues such as diabetes or high blood pressure, usually visit their doctor at least once a year to get prescriptions renewed. That visit can take the place of a traditional annual exam, Miller says. "When the doctor checks to make sure things haven't changed [in regard to medications], it's a good time to review preventative measures."
Miller is an advocate of consumers using the Internet to research health issues. He encourages patients to ask their physicians about controversial treatments, such as the recent debates over mammograms and prostate blood tests, or even, "Do I need to take calcium or vitamin D?"
"An educated or informed public isn't a bad thing," Miller says. "Most people know the Web can be a morass of bad information and they filter it out."
Hansen estimates that a routine physical costs $250 for a person without health insurance but is a good investment.
"I would recommend people doing it twice in their 20s, three times in their 30s and four times in their 40s and so on," he says. Again, he says, the emphasis should be on discussing with the physician your risk factors, family history and what you can do to remain healthy.
"You can ask the doctor, 'What are my potential risk factors for heart disease and cancer?' Talk about any problems you have with getting good exercise and being active. If those three questions were asked, it would cover the biggest areas of preventative health care."
Miller says medicine is an "artisan-based craft."
"Everyone has different needs and there are many areas where we don't have the right answer all the time," he says. "The most valuable part of the visit is the discussion piece — it's about the conversation. And that will guide further evaluations of the patient."