KEEP THE MONEY IN YOUR SAVINGS ACCOUNT AND THE PARTS IN YOUR BODY:

The Case Against the Annual Checkup : Going to the doctor when you're not sick does more harm than good. (Brian Palmer, Aug. 20, 2013, Slate)

[H]ere's a free bit of advice: If you're not sick, don't go to the doctor.

There are two kinds of arguments against the adult annual health checkup. The first has to do with the health care system overall, and the second has to do with you personally. ]...]

Most adults go to the doctor when they're legitimately ill, and competent physicians use those appointments as opportunities to offer unrelated preventive services. About three-quarters of the people who get an annual checkup have been to the doctor for some better reason in the previous 12 months. Very few preventive health services are required every year, or even every two years. Even if you go years without seeing a doctor--congratulations, by the way--you can get those services (screenings for various diseases or counseling on smoking cessation or weight loss, for instance) without wasting your time at an annual checkup.

Many primary-care doctors order totally unnecessary procedures during annual exams, squandering patients' time and our health care dollars. Perhaps they just want to make patients feel like they're doing something. Here's where this stops being about the efficiency of the health care system and starts being about you: unnecessary screenings can be hazardous to your health.

People have a hard time viewing screenings as dangerous. Take, for example, the "hands off my mammogram" uprising that followed a 2009 government recommendation that mammograms be started later in life and conducted less frequently. Reactions of this kind appear to be based on two misunderstandings. First, many people overestimate the accuracy of screening exams. The false positive rate for a single screening exam is usually low, but when you take them year after year, it becomes very likely that a healthy patient will receive a false positive. A 2009 study showed that, for many cancer screening tests, a patient who undergoes 14 screenings has more than a 50 percent chance of a false positive.

That leads us to the second misunderstanding. Contrary to popular belief, following up on false positives isn't just expensive and anxiety-inducing--it's dangerous.

"In a urinalysis, doctors look for protein or blood in the urine to check for chronic kidney disease," explains Ateev Mehrotra, a doctor who studies health care policy at Harvard Medical School and the RAND Corporation. "If it's positive, you do a repeat. If that's positive, you ultrasound the kidney and then possibly do a biopsy. The risk is low, but kidney biopsy can lead to hemorrhage and even kidney removal."

Kidney biopsies are perfectly reasonable procedures when a patient has symptoms of kidney disease. But looking for disease in an otherwise healthy patient, then performing a series of interventions to prove the screening test wrong--that's bad medicine.

There's also the risk of unnecessarily "medical-izing" minor illness. People who go for annual checkups typically report symptoms that they would have otherwise ignored. In some cases, that's a good thing--some patients minimize their symptoms and ignore the warning signs of serious illness. Most of the time, however, it forces the physician to investigate and treat a problem that would have gone away on its own.

Posted by Orrin Judd at August 20, 2013 2:22 PM
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