Scientists and students question efficacy of annual physicals

Kartik Nath, Staff Writer

Across campus, students are gearing up for their study abroad experiences, overseas or domestic and have realized that they are required to have an annual medical exam. As young college students, the common thinking is, “We’re young and don’t need a checkup” or, “This is a waste of time, I’m in great health.”

A yearly checkup is practical, as a doctor will check vital functions and make sure that your body is running in great shape. Usually, these exams consist of questionnaires or screenings to assess an illness or hidden risks, physical exam, discussion about preventative actions and routine tests, such as bloodwork and urinalyses. However, there is growing sentiment in the medical field that these yearly exams do nothing to improve a person’s disease or mortality risks and some experts are advocating for the end of annual exams.

This growing divide in healthcare begs the question: do we really need an annual physical exam?

In the growing debate, one camp of medical experts believes that annual physical exams are unnecessary. One of the most well-regarded opinions clarifying the argument was written in the New England Journal of Medicine in 2015 by Dr. Ateev Mehrotra, an associate professor of Health Care Policy at Harvard Medical School and Dr. Allen Prochazka, a professor of Internal Medicine at the University of Colorado School of Medicine. They cited two systematic studies to support the two main arguments against physicals: (1) “They do not reduce mortality and morbidity,” (2) “They have been associated with increased patient worry and increase use of preventive care.”

These two arguments make sense, as we keep hearing about how primary care providers lack adequate time to spend with every patient, so these exams may not be very thorough and produce misleading results that could lead to patient worry. However, there is a lack of longitudinal and large studies to support these claims.

Mehrotra and Prochazca raise the argument that annual physicals are “harmful” to people because components of the traditional exam, such as the “comprehensive physical exam” and routine work (e.g urinalysis) have “low specificity,” meaning that some results could be misdirected based on random error and will end up with false positives.

Another important argument that Mehrotra and Prochazca make is that reducing the number of physical visits could save a lot of money in the long run, as physical visits add up to over “$10 billion a year” and could save a lot of the primary care providers’ time. This money and time could be spent to address urgent matters, such as expanding services to at-risk areas.

However, they agree that trying to convince providers to give up the annual exams will be difficult because many providers use the exam to establish the doctor-patient relationship and make sure that every patient is receiving appropriate care.

The argument for eliminating annual exams has not been proven to be strong enough for the medical community. Dr. David Himmelstein published an opinion in the Annals of Internal Medicine in 2016 arguing that there is insufficient evidence to conclude that annual physical exams should be eliminated.

He critiqued a review published in 2012 of 12 studies that supported that the exams did not reduce illness. Also, he found another review of 33 studies that showed that exams benefitted people, especially those who are classified in high-risk groups.

So, for now, physical exams are regarded as beneficial in order to make sure everyone is functioning normally. It will take years and lots of data to convince primary care providers to abolish the yearly checkup.