When I got married in 1989, the last time I had visited a physician’s office was more than a quarter century earlier. Oh, I’d been to hospitals (broken arms, shattered glass, shattered vertebrae, horrendous wrecks), but to a physician per se- nope.
It took my wife more than a year to convince me to set up a physician visit. Because I did not believe that an annual visit to the doctor was necessary. But, she convinced me that I needed to do so- and began visiting someone I knew. (If you need a great doctor, I would not hesitate to recommend him.)
But, it turns out, I was right. Drs. Krosboll, Jorgensen, Larsen, and Gotzsche of the Nordic Cochrane Centre (Copenhagen, Denmark) recently published their analysis of the situation in the British Medical Journal. But, before I discuss their findings, I need to explain a Cochrane Review.
These Cochrane analyses of evidence-based health care are systematic reviews that are used to determine the accuracy of diagnostic tests for specific conditions or the effects of interventions in people to prevent, treat, or rehabilitate their conditions. While powerful, they rely upon clearly formulated questions. (You remember- the old hypothesis theory of investigation you barely learned in elementary school.) Then, the primary research (direct, non-anecdotal evidence) is examined, collated and assessed to verify the hypothesis or prove it wrong.
So, Krosboll et. al. searched for randomized trials that compared health exams (general populations, screened for more than one disease or risk factor in more than one organ system) with no health exams for subjects that were NOT previously selected for disease or risk factor conditions (which would skew the results). Moreover, geriatric trials were excluded. (In other words, I would not be among the subjects in any of these studies.)
[They found 16 trials, of which 14 had outcome data (a total of 182,880 subjects). Of the 14 they examined, nine had mortality data (11,940 deaths, 0.99 risk ratio) and eight had cardiovascular mortality (4,567 deaths) and risk ratios of 1.03, with eight more yielding cancer mortality data (3,663 deaths, 1.01 risk ratio). ]
In a nutshell, their data indicated that routine medical exams had NO effect on overall deaths, disease-related deaths, hospitalizations, or costs. And, this was not the first such study that yielded these findings. In 1979, the Canadian Task Force on Periodic Health Examination (next time you complain about national health care- think of this kind of panel existing in the US- oh, it does… but you never hear about it- The US Preventive Services Task Force), found the same thing. Their recommendations was similar; that the annual physical requirement should be scrapped; instead better (and more expensive) health packages be developed for various health needs as they pertain different stages of human life. Consider that, in the US, the 2009 National Ambulatory Medical Care Survey found the primary reason folks visited their doctors was to comply with the the annual physical exam requirement of their health care plans.
Now, the reason this happens is we expect the annual exams to catch medical problems before they get out of control. Of course, there are negatives- time away from work, potential unnecessary tests, and false assurances that everything is ok. (That last one: “What do you mean he just died? He visited his doctor yesterday!” sounds awfully familiar, with the stress on awfully.)
About 12% of our primary healthcare providers’ time is being spent doing things that has no medical evidence supporting those practices. And, we already know that our primary care physicians are in very short supply. Yet, our health care plans yield financial incentives for physicians to provide these annual exams. It’s going to get worse! PPACA (“Obamacare”) now requires an annual wellness exam- because health plans must provide the same benefits as Medicare does. (Remember: Medicare is for the elderly population, not the general population.) Yes, we spend as much money on these exams as we do for breast cancer treatment and prevention. Think about that for a moment.
There are positives about this practice that we can’t omit from mention, though. The annual exam does promote time with one’s doctor, to insure there is a ‘relationship’, one where questions and answers can be provided that are not focused on the one ailment that brought you to the doctor in the first place. And, unless and until we have universal health care records, having “your” physician have all your data at his/her fingertips when you come only occurs with serial visits to the same practice.
So, let’s summarize the real findings from these studies. Little kids- still need annual visits. Infants need to see the physician way more frequently than that. But, once we are out of our teen years until age 50 to 60, then a routine exam every five years is probably ideal. But, we need to make health screenings cheaper, easier, and more prevalent: For diabetes, blood pressure, and cholesterol, those checks need to be every two to five years. Unless, of course, you are overweight, smoke, or have other conditions (like my life-long breathing maladies). Then, it’s off to Doc we go!
An annual exam is good preventative maintenance, I believe. Wonder how many people actually heed the advice they may be given at them though? (ie: no I HAVEN’T lost those 20 lbs…)
I think diagnostic tests once or twice yearly are fantastic maintenance, Alessa… But, if you are under the age of 55 and over the age of 18- and not having a baby… then, annual checkups are not the best use of your (and my insurance) money…
I don’t know, Roy. I agree with the assertion that it’s important to develop a relationship with your doctor, but the last time I saw my GP (and he’s a great, personable, approachable fellow) he barely even looked at ME, he was concentrating so hard to get all the info entered into his laptop. Plus, with a large family and high-deductible insurance, annual visits aren’t even possible at our house. But in a perfect world–it sounds like a good idea.
Amy recently posted..A note about raising boys
I’ll bet that your insurance plan covers the annual visits, Amy. one of the little secrets that most Americans don’t know is that the insurance coverage we (generally) have does something completely different than we think it does. It gives us “volume pricing”.
If you (heavens forbid) don’t have insurance- then when you visit the doctor, your fees can run $ 1500 easy. But, if you have insurance, they only approve $ 500. So, even if that is part of your deductible, you just saved $ 1000! (Yes, you could have spent $ 500 toward your deductible- but if you have high deductibles, you also have HSA, which means that those costs are deductible from your gross income- which means that $ 500 really only costs something between $ 400 and $ 250… (after tax costs).
Your site was being ornery and wouldn’t let me finish my comment! I was going to finish by saying that eating an excellent diet and exercising and adopting other good health practices can go a long ways to keep you from having to go see the doc too often.
Amy recently posted..A note about raising boys
I agree wholeheartedly with that, Amy! Great addition to the conversation!
I do believe that hugh medical Companies herd people through tests of every kind just for the money involved. I am lucky that I have the VA and receive some of the finest care in the country. I admit that a visit can take up to half a day, and I think they draw way more blood than needed, they do take care of me and I look forward to my annual review.
Chef William recently posted..Nigella Seeds
I think the medical companies to which you refer, Chef William, are the physicians who make the money off those tests- or desire those tests to “insure” they you won’t sue them and test their insurance…
My old doctors office used to do very througough physical exams, you could talk and ask questions. They did ekg’s on me yearly because I often complain of my heart racing. That doctor left about 3 years ago and since then the new doctors they bring in have offered less and less care. This past year they did weight and blood pressure that was it. I wanted to talk about my heart again since it was still racing quite often and I was feeling tired. They told me I had to make a seperate appointment because they can only charge one code per visit to my insurance company. A week late I ended up in the ER with my heart racing and a pain going down my left arm. Luckily medication got my heart into a normal rhythm and I was released a few hours later (after a whole slew of tests). I now have a cardiologist and am still searching for a new regular doctor. I don’t think everyone needs yearly physicals, unless they already have a medical condition like diabetes, heart problems, high blood pressue, high cholesterol etc.
Thanks for the visit, Diane..
I would start looking for another practitioner, if these new “replacements” are scrimping on the services they offer. And, as I wrote to Bonnie, it’s not your job to maximize their revenue- it’s your job to get your needs handled- properly. I’d check out the docs on your health plan- and ask pointed questions to make the educated choice.
And, I certainly agree with your last statement1
This is timely as I have just been talking to my husband about getting a check up. He’s 59 and it’s been a few years, so I think he’s due. I’d like to have him around as long as possible. I agree with a lot of the points here. My main deal right now is the medicare abuses that I see as I take my dad and father-in-law to so many dr visits. I think the billing thing is very out of hand and struggle with balancing going and not going. Sometimes I think they are exposed to more problems when they go to the doctor.
Bonnie Anderson recently posted..Let Your Imagination Go Wild on Valentine’s Day
Bonnie-
I’m not so sure that these are Medicare policies, as much as they are processes that healthcare practitioners have adopted to maximize their revenue. They try to limit each visit to one item (and shorter times, which means more traveling time for you) so they can see 25- 40 folks in a day- and get multiple visits for the same patient in a given reimbursement period.
Your post has made me think back to how often I’ve had exams, and I don’t believe it’s ever been yearly. I tend to go only when necessary, and eventually have all the blood work and testing done. My kids go yearly. They have to just to get clearance for sports camps. I can definitely see where it would be more necessary for people over 55.
Suerae Stein recently posted..ZUMBA? ME? I DON’T THINK SO!
So, I am thrilled that you’ve been prescient about the new recommendations, Suerae. Just don’t scrimp on the regular testing (which don’t have to be associated with a doctor’s visit).