Ezekiel J. Emanuel, a prominent oncologist and a former Special Advisor on Health Policy to the Director of the Office of Management and Budget, wrote an Op-Ed in The New York Times last week that caught our attention. In it, he argues that although 45 million routine physicals will take place in the United States this year, their value to our overall health is basically zero.
He writes:
There is only one problem: From a health perspective, the annual physical exam is basically worthless. In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint. The unequivocal conclusion: the appointments are unlikely to be beneficial.
Studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.
If they are worthless, why do so many people continue to get them – and why do doctors insist on giving them? Emanuel goes on:
There have been stories and studies in the past few years questioning the value of the physical, but neither patients nor doctors seem to want to hear the message.
- Part of the reason is psychological; the exam provides an opportunity to talk and reaffirm the physician-patient relationship even if there is no specific complaint.
- There is also habit. It’s hard to change something that’s been recommended by physicians and medical organizations for more than 100 years.
- And then there is skepticism about the research. Almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story.
He is undoubtedly correct about the amount of money spent and the macro-level impact of that money on the overall health statistics nationwide. It’s possible, however, that he is underestimating the micro-level impact of a visit, even a short one, to the doctor. He acknowledges the psychological impact of a face-to-face exam, and although the likelihood of a life-saving diagnosis occurring during an exam is slim, the possibility is there and remains a comfort to many.
As we wrote in Physical Exams Still A Crucial Part of Healthcare’s Future, even in this world of technology, smartphones and health and wellness apps, the physician-patient relationship remains vital, and the physical exam is a crucial touch point. It’s our goal at Steelcase Health that the physical exam, no matter how often it occurs, is as efficient and effective as it possibly can be.
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