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Value of Annual Physicals Debated

June 27, 2005
Even though extensive research finds little value in an annual physical examination for adults in good health, doctors and patients alike continue to want them, according to a study in the June 27 issue of Archives of Internal Medicine.

Evidence-based guidelines developed in the last 20 years suggest selective screening based on the patient's personal and family history and overall risk, rather than a routine annual physical examination and testing for asymptomatic adults, according to background information in the article.

Despite these guidelines, the authors report, a high percentage of the general public wants an annual physical examination and extensive testing. The current attitudes of primary care physicians toward annual physical examinations have not been previously assessed.

Allan V. Prochazka, M.D., M.Sc., of the Denver Veterans Affairs Medical Center, and colleagues conducted a survey of the attitudes and practices regarding annual physical examinations of a random sample of primary care physicians (PCPs) including physicians specializing in internal medicine, family practice and obstetrics/gynecology who were located in the metropolitan areas of Boston, Denver and San Diego.

Of the 783 primary care physicians responding to the survey, 65 percent believed an annual physical examination is necessary in addition to seeing patients for acute medical conditions and chronic medical illnesses.

"Nearly all physicians (88 percent) indicated that they performed annual physical examinations. Seventy-eight percent believed that such an examination was expected by most patients," the researchers report.

"Surprisingly, in view of the current evidence, 74 percent thought that an annual physical examination improved the detection of subclinical illness [illness without symptoms]," the authors report. "Sixty-six percent believed that annual physical examinations are covered by insurance, 63 percent thought they were of proven value, and 55 percent disagreed with the statement that such examinations were not recommended by national organizations."

"It is clear that, despite national organizations no longer recommending annual examinations and lack of evidence supporting routine laboratory testing in asymptomatic individuals, the public desires such examinations and primary care physicians continue to believe in the value of these examinations," the authors write.

The authors expressed dismay that, "many of those on the front lines of primary care do not appear to accept the targeted recommendations of the guidelines."

In an editorial accompanying these studies, Patrick G. O'Malley M.D., M.P.H., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and Philip Greenland, editor of the Archives of Internal Medicine, suggest there are many potential reasons for the discordance between evidence and practice regarding the annual physical examination.

"One possibility is that patients and their physicians value something about what the annual physical provides that the evidence has failed to address," they write. "In particular, it may well be that the patient-physician relationship is what is being valued. Meaningful relationships take time, and the current culture of health care does not explicitly value time spent on developing relationships between patients and physicians."

"Perhaps the annual physical has become the forum to serve that purpose, in addition to providing opportunities to address the other items of health care not provided by our current standards of visit frequency and time."

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