FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PREVENTIVE CHECK-UPS MODERN REPLACEMENT FOR ANNUAL PHYSICAL

Question: An online list that I belong to had a discussion recently among several family doctors on the topic of the annual physical. The general consensus among these family docs was that the annual checkup was no longer considered good medicine and that periodic checks of areas where a patient's family history or personal history indicated higher risk was much better. Is this true? Is the annual physical an outdated procedure?

Answer: To answer this question, I first need to define clearly what is meant by the term "annual physical." The type of examination referred to by this term was the standard of health care 20 years ago. At that time, it was recommended that every adult have a complete history and physical examination every year. This involved reviewing all the details of your medical history and then performing a physical examination covering all major body systems. Necessary tests were then ordered for evaluation of any problem areas that were discovered. This type of examination requires 30 to 60 minutes of the patient's time and somewhat longer for the physician, who must carefully record the information.

The annual physical is no longer considered the standard of care. This change is partially due to the high cost of this type of examination. Today, each of us rarely pays personally for our health care. Instead, our insurance company -- whether traditional insurance or managed care (actually "managed cost" is a better label) -- pays the bill. These companies only want to pay for services that have shown their cost is justified by health benefits. The traditional "annual physical" isn't cost effective.

The demise of the annual physical doesn't mean that you should only see your doctor when you have an acute illness. Instead, you should see him or her annually for a preventive health examination; at least that is what the U.S. Preventive Services Task Force recommends for most of us. The specifics of this periodic examination vary depending upon your age, gender and other risk factors for disease. The focus is upon preventive health care and interventions that are of proven value instead of the sore throat, elbow pain or other specific problem that is the usual reason for a trip to the doctor.

A preventive examination for a child includes many components, such as assessing the normal growth and development, diet and exercise recommendations, recommendations for accident avoidance, and immunizations. Adolescent patients have additional needs. The risk of sexually transmitted diseases -- as well as the use of tobacco, alcohol and other illegal substances (a reminder that alcohol is illegal for those under 21) -- should be assessed and discussed with the patient. Adults have a higher risk of high blood pressure, increased cholesterol, heart disease, breast cancer, cervical cancer or prostate cancer. These items are added to their list of targeted concerns.

So, I agree with the other family physicians on your listserv. The "annual physical" is passé, but with today's high-tech tests and advanced screening techniques, it has never been more advantageous for you to see your physician for periodic preventive health checks.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.