April 6, 2015

CONSUME MEDICINE ONLY WHEN YOU'RE SICK:

Ritual, Not Science, Keeps The Annual Physical Alive (Jenny Gold, April 6, 2015, Kaiser Health News)

[9]2 percent of Americans say it is important to get an annual head-to-toe physical exam, according to a Kaiser Family Foundation poll (KHN is an editorially independent program of the foundation). And 62 percent of those polled said they went to the doctor every year for their exam.

But the evidence is not on their side. "I would argue that we should move forward with the elimination of the annual physical," says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.

Mehrotra says patients should really only go to the doctor if something is wrong, or if it's time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view. "When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm attacking moms and apple pie," Mehrotra says. "It seems so intuitive and straightforward, and [it's] something that's been part of medicine for such a long time."

But he says randomized trials going back to the 1980s just don't support it.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but that adds up fast.

"We estimate that it's about $10 billion a year, which is more than how much we spend as a society on breast cancer care," Mehrotra says. "It's all a lot of money."

And then there's the risk that a doctor will run a test and find a problem that's not actually there. It's called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He generally avoids giving physicals.

"I generally don't like to frighten people and I don't like to give them diseases they don't have," Rothberg says. "I mostly tell my family, 'if you're feeling well, stay away from doctors. If you get near them, they'll start to look for things and order tests because that's what doctors do.' "

"The flip side of that is if you're not feeling well, don't keep it to yourself. Don't minimize it. Don't pretend it's not there," he adds.

Personally, I had one last century, which seems recent enough.

Posted by at April 6, 2015 6:31 PM
  

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