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Follow the Money? Annual Physicals Disdained



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Two people very close to me were helped tremendously by having their serious illnesses caught during an annual physical before they experienced noticeable symptoms. The annual physical used to be the core of a doctor/patient relationship. But now — along with some formerly recommended cancer screenings — the annual physical is becoming actively discouraged. 

Color me cynical. Obamacare is expected to cause a major doctor shortage. Obamacare also has cost-saving as the core value of centralized control. Perhaps we should thus not be surprised that we are seeing retractions of once standard medical recommendations, with the latest example in the Washington Post, a piece entitled ”Annual Physical Exam is Probably Unnecessary if You’re Generally Healthy”:

The annual physical became popular, in part, because it seems so logical that a regular exam might catch medical problems before they get out of hand, says Ateev Mehrotra, a health policy researcher and physician at the University of Pittsburgh School of Medicine. But given the lack of evidence that the yearly ritual improves health, he says, “my own view is that the medical community should no longer encourage patients to receive an annual physical.”

False positives lead, to unnecessary treatment, false assurance of health leading patients to ignore symptoms, etc. But I worry that it may actually be a case of follow the money:

Mehrotra says that annual physicals also are straining the medical system. “We’re spending 12 percent of our primary-care time on something that has no evidence to support it.” Primary-care doctors are in short supply. “If physicians stopped doing annual exams and used that time to accept new patients, it would greatly alleviate the problem.”

But that’s unlikely to happen soon, he says, because so many health-care plans create a financial incentive for physicians to provide annual exams. “As a society, we’re spending about as much money on annual exams as we are on breast cancer. That’s a tremendous amount of money for something with no evidence base,” Mehrotra says. He’s particularly alarmed that Medicare recently introduced an annual wellness exam, because health plans are required to cover the same range of preventive services as Medicare. “This perpetuates the myth that the annual physical is important,” Mehrotra says.

Sorry, I just don’t trust advocacy urging us to receive less preventive care that just happens to come along at the very time when a “less is more” approach is thought by some to serve the collective health-care system.

People will have to judge these reports for themselves, of course. But as for me: I plan to work all of these issues out with my personal physician, whom I trust to make recommendations based on his knowledge of my individual health and family history. 



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