11/15/2015

A check to check: Do you really need an annual physical?

A check to check: Do you really need an annual physical?
A check to check: Do you really need an annual physical? - In the US, annual physical exams are part of the structure of our health care system. 

For adults, even if they are perfectly healthy, visiting a doctor yearly long been regarded as the basis of good care.  

But recently, experts have begun to wonder if our collective belief in this ritual is reasonable. Do the benefits of annual care really as big as we think? Patients can get the benefits of the annual review by other means?

In a recent editorial in the New England Journal of Medicine, Drs. Allan Prochazka Ateev Mehrotra and explore the complex issues surrounding the annual medical examinations. In the name of improving the "value" in health care argue that these routine visits should not continue.


The evaluation of benefits and risks of the annual review 

As physicians and experts in health care policy, the authors understand that it will be difficult for us to change this practice.

Although a number of professional guidelines recommend that doctors should not follow the tradition of the annual review, the data show that the frequency of these tests has not diminished. Doctors and patients are very attached to the practice, and polls show that most believe it should continue.

But what are the real benefits of this practice? A careful review of several large studies have shown that these annual visits make no difference in health outcomes. In other words, you are seen by your doctor once a year does not necessarily prevent getting sick, or even help you live longer.


And some of the components of an annual visit can actually cause damage. For example, laboratory tests and tests that are controlled in healthy patients (unlike individuals exhibiting symptoms or diseases known) are statistically more likely to be "false positives" - that is, when the test results suggest there is no problem.

Although these inaccurate results reach only a small percentage of the 200 million adults who undergo these tests, monetary and emotional costs, practices are huge.

Drs. Mehrotra and Prochazka indicate that reducing the number of annual tests to save time and money. The time that primary care physicians currently spend on these visits could be used to address urgent needs and expand access to health care for the needy.


They recognize that this change will be a hard sell, in part because many physicians and patients perceive the annual visit as a critical opportunity to cement the doctor-patient relationship and a way to ensure that people receive appropriate examinations and care preventive.

Three steps to better care model 

To encourage this change, the authors propose three steps. First, they recommend a new type of business to concentrate solely on the doctor-patient relationship.

This would allow those who are new to a doctor to have a first visit to establish a relationship, and allow others to be seen in a routine range (perhaps every 3 years or less) to keep. The focus would be more on medical and social history, and less on laboratory testing or screening.

Secondly, they recognize that if the annual survey should be discarded, primary care doctors will have to find a way to proactively monitor the care of their patients in preventive care.


They suggest that the wait for patients to keep their annual visits to check this approach is too "passive" and encourage practices to move to "active participation" of their patients. Ways to do may include risk assessments online, waiting questionnaires, and a review of preventive care at each visit to the doctor. 

Finally, they suggest that doctors and patients to accept this change, taxpayers must make changes. The authors recommend that no health plans and government programs to pay for annual visits and regular checks used as a measure of quality of care.

The disappearance of the annual review will feel like a loss for many patients and their doctors. But the authors encouraged to think creatively to keep important values ​​of this visit new and more effective ways.


His "verify" suggests that the "health check" in need of major surgery. To push the metaphor, if we follow through their suggestions and like any procedure, you will be healthier in the end, but we will all probably feel a little pain we are going through it.

This discussion is not only theoretical for me. As primary care physician, I agree that the benefits of the annual review can and should be achieved by other means. At the same time, I know it will be difficult to make these changes with my patients.


The interruption of the annual physical is experienced as a loss, as a form of abandonment, for some. The most powerful way to treat this is to recognize and name the loss, and letting patients know that significant portions of the Annual suffer: attention to their needs, when they need care and attention to your Routine preventive care - just all without the annual visit.
By: Amy Ship, MD.

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