Doctors Still Support Annual Exams

Top national health groups no longer recommend the annual physical exam for most healthy adults, but it appears that most doctors and their patients continue to believe in them.

In an earlier study, researchers from the University of Colorado Health Sciences Center reported that most patients still think annual exams are beneficial. Now a new study from the same research team shows that doctors feel the same way.

"When subjected to careful scrutiny, a comprehensive annual physical examination with laboratory testing in unselected healthy adults has not been proven as a means for disease detection and prevention," the researchers write.

Of the close to 800 primary care doctors questioned, 94% said they believed that annual physical exams improved the doctor-patient relationship and provided valuable time for counseling patients. Roughly nine out of 10 doctors said they performed annual exams, and eight out of 10 said such exams were expected by most patients.

The study is published in the June 27 issue of the Archives of Internal Medicine.

"The idea that all adults require annual exams that include the same battery of tests is not something that has been borne out by the data," lead researcher Allan V. Prochazka, MD, tells WebMD.

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One Size Doesn't Fit All

He adds that a standardized annual physical may fail to address a patient's specific medical needs. A 50-year-old, overweight man with a strong family history of heart disease, for example, should not get the same preventive care as a 35-year-old man with few cardiovascular risk factors.

"It is important to individualize preventive care," he says. "What may be right for me may not be right for you."

In 1996, the U.S. Preventive Services Task Force changed its policy regarding annual physical exams, stating that there was insufficient clinical evidence to support the practice. The American Medical Association and other large health groups have also abandoned the notion of an annual physical, calling, instead, for testing to be performed based on individual risk factors for disease.

In the newly published study, physicians specializing in internal medicine, family practice, and women's health completed a survey designed to assess their attitudes about annual physical exams.

Just over half believed that annual exams were still recommended by the nations top health groups, and three out of four thought they improved the early detection of illness.

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Intangible Benefits

While the clinical evidence does not back up this belief, Washington, D.C. internist Patrick G. O'Malley, MD, says the studies that have been done to date haven't addressed the less tangible benefits of annual exams.

O'Malley co-authored an editorial accompanying the study. He is chief of the division of general internal medicine at Walter Reed Army Medical Center.

"There just isn't enough time in a typical office visit to address all of the concerns and questions that patients have," he tells WebMD.

O'Malley says he finds the routine, well-patient office visit an invaluable tool for exploring the concerns of his patients and educating them about what they can do to improve their overall health.

American Academy of Family Physicians president-elect Larry Fields, MD, agrees that there is little justification for annual physical exams. But he adds that an annual visit to a doctor is "critical."

"There is no single battery of tests that every patient needs every year," he tells WebMD. "But even if someone is seeing their physician on a regular basis for specific health concerns, at some point they need to have that annual discussion about preventive health."

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By Salynn Boyles, reviewed by Brunilda Nazario, MD

SOURCES: Prochazka, A. Archives of Internal Medicine, June 27, 2005; vol 165: pp 1347-1352. Allan V. Prachazka, MD, professor of medicine, University of Colorado Health Sciences Center, Denver. Patrick G. O'Malley, MD, MPH, chief of the division of general internal medicine, Walter Reed Army Medical Center, Washington, D.C. Larry Fields, MD, president-elect, American Academy of Family Physicians.