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Commentary—The Death and Rebirth of the Annual Physical?

30/10/15 Michael R. Wasserman, MD, California Association of Long Term Care Medicine;

A recent news article discussed a series of articles in the New England Journal of Medicine that presented opposing opinions on the usefulness of the annual physical. Many experts question the value of an annual physical because the likelihood is low that examining a person who feels perfectly well will reveal a specific disorder that requires treatment. However, perhaps we need to think about the annual physical differently to see whether it offers value besides uncovering a hidden illness. What might that value be? Many doctors feel that the annual physical is about solidifying the relationship between the doctor and the patient and allowing them to catch up with what has been going on with the patient’s health and life in general. In addition, the annual physical provides other benefits. During an annual physical, doctors recommend specific preventive care, and improve the likelihood that people will carry out those recommendations. The annual physical also serves to reassure patients that they are well, decreasing unnecessary worry.

Perhaps the problem has to do with how we define the annual physical. To some patients, as well as their doctors, the annual physical means getting a lot of routine laboratory, radiographic, and other tests. And we know that there is little value in annual electrocardiography (ECG), chest x-ray, or most laboratory tests.

The government encourages doctors to perform an annual wellness exam in patients on Medicare. This exam provides an opportunity for Medicare beneficiaries to have their physicians get to know them from a variety of vantage points, including their function, and cognitive and social status. Although eliminating this visit might save money, it might also increase costs by eliminating the one visit that focuses on improving communication between doctors and patients. 

Perhaps a better idea is to use the annual physical to improve the ability of patients to communicate with their doctors. In today’s fast-paced world, isn’t there value in assuring that the doctor and patient have a little time each year to maintain their relationship and review the things that have changed and those that haven't?

Dr. Wasserman is The Manuals' Editorial Board Reviewer for Older People's Health Issues.