April 29, 2013

Should We Get Regular Checkups and Screenings? Maybe Not.

A recent study at Copenhagen’s Nordic Cochrane Center found that routine medical exams did not reduce deaths, hospitalizations, or costs.

The conclusion is based on big numbers and warrants our consideration: Researchers considered 14 separate, comprehensive studies that followed about 182,000 people who did and did not receive routine, general health checkups.

I’ve written about the questionable value of routine health screenings (just enter "tests" in "search this blog" at right). This issue is front and center for me now since my internist of 20 years is switching to a "boutique practice." That new arrangement, should I opt in, would require that I shell out $1,500 a year for the privilege of keeping him as my primary care physician.

I'll be exploring these issues beginning tomorrow. To set the stage, here's a summary of Christine Aschwanden’s article in the February 8 edition of The Washington Post on the latest findings regarding annual physicals.

While many of us continue to see our doctors every year for check-ups and screenings, the case for NOT doing so has been around for a long time. In 1979, an official Canadian panel drew this conclusion:
The routine annual physical examination should be discarded in favour of a selective plan of health protection packages appropriate to the various health needs at the different stages of human life.
Meanwhile, In America…
South of the border, advice isn’t quite as definite. Dr. Michael L. LeFevre, co-chair of the U.S. Preventive Services Task Force, says his group makes age-specific recommendations about screenings. They neither suggest nor discourage annual exams.

Americans – certainly those armed with comprehensive insurance coverage – are making their own decisions. Surprisingly, the number one reason we visit our doctors is to receive annual regular physicals, according to the 2009 National Ambulatory Medical Care Survey.

Isn’t pro-active planning -- with regular doctor visits -- a hallmark of effective preventive medicine? Well… not really, according to the Cochrane report.

Dr. Ateev Mehrotra, a health policy researchers at the University of Pittsburgh School of Medicine, cautions that routine tests often lead to worrisome false positives (thus generating still more tests), don’t usually really help patients, expose them to unnecessary tests (including harmful radiation), needlessly take people away from work or home, and impose a gigantic burden on the nation’s healthcare bill. Said Mehrotra: “My own view is that the medical community should no longer encourage patients to receive an annual physical.”

Mehrotra thinks annual physicals burden the system, especially since there is a shortage of primary-care doctors:
We’re spending 12 percent of our primary-care time on something that has no evidence to support it,” he says. “If physicians stopped doing annual exams and used that time to accept new patients, it would greatly alleviate the problem.
That’s a tough case to make, especially when Medicare just provided coverage for an annual wellness exam. Now, other health plans will cover the same services. This development, according to Mehrotra, “perpetuates the myth that the annual physical is important.”

In Defense of the Annual Physical
Naturally, there are voices on the other side.

Dr. Sung T. Kim practices family medicine in Centerville, Virginia. He thinks the annual exam fosters the important doctor-patient relationship, enables him to assess patients’ mental health, and simply creates useful “quality time.” He also finds changes from one year to the next in patients' key stats, like cholesterol or blood pressure. He adds:
When they come in for an acute visit, a lot of times we can only focus on that problem. An annual visit allows me to take time to spend that extra 10 or 15 minutes really talking. When we don’t see a patient for two or three years, there could be a lot of things we are missing in the interim.
So, What’s a Patient to Do?
Being a well-informed patient, who chooses to take charge of his or her own health care, is the best place to start. Patients who feel as though they are on an assembly line as they are processed through their annual physicals may question their value.  But patients who are given plenty of time to talk to a primary doctor who they have dealt with for years may find those annual meetings useful and reassuring, as Dr. Sung suggests.

I reported recently on my own doctor's similar views. See http://bit.ly/MpbdSg

Want to see what the government recommends for you? Here are the guidelines from Dr. LeFevre’s U.S. Preventive Services Task Force. Simply enter your gender and age, then click the “get started” button. The results are interesting.

Coming next: My impending decision regarding my internist's switch to a concierge practice.

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