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Are Physicals A Waste of Time?

Feb 4, 2013
By Malcolm Thaler
Physical Exam

Every week several patients sit down in my office and offer some remorseful variant of “I’m sorry I haven’t been in for a while; I’m way overdue for my annual physical.” I assure each patient that he or she hasn’t committed any crime, nor have they done themselves any serious medical harm. But is that really true?

There’s no evidence that annual physicals significantly improve health and prolong life. A new report from the BMJ (British Medical Journal) offers further evidence that regular health check-ups offer no meaningful benefits with regard to overall health, hospitalization rates, disability, anxiety, or absence from work. The study compiled the results of 16 previous trials to reach this conclusion.

What’s the Story with Annual Physicals? Do I Need One?

This study is far from flawless. For example, it excluded trials that targeted people over the age of 65, who are the most likely to benefit from periodic checkups. In addition, most of the trials tracked patients for only five years or fewer, which may not be long enough to see the effects of early detection and screening. Finally, many of the trials did not include lifestyle interventions in their wellness checks.

Further, we know that certain screening interventions do work, such as obtaining a colonoscopy at age 50 (which reduces the risk of colorectal cancer); cervical cancer screening; blood tests for HIV and hepatitis C; and even lung cancer screening in heavy smokers who are at risk. Regular vaccinations are effective at preventing disease as well. And last–but hardly least–simply having appropriate conversations with your health care provider can make a real difference in your health. Another recent study, for instance, showed how simply discussing driving risks with those who might be unfit to drive can cut car accident rates almost in half.

This new study misses the boat. The answer lies in the word annual. If you’re well and live a healthy lifestyle, there’s little reason to maintain a strict schedule of annual physical exams. If you still wish to have an annual checkup, we certainly won’t discourage you. But don’t feel you’ve let yourself down and set yourself up for some medical disaster by missing your yearly physical.

What Can I Expect at a Physical?

A physical exam at One Medical is a comprehensive evaluation of your health. It enables us to get to know you as an individual in ways that simply seeing you for a cold or a sprained ankle may not. We focus on your health goals, and also emphasize disease screening, prevention, and education. We may also recommend specific tests or referrals, depending on your specific situation.

When it comes to deciding what diagnostic tests (if any) to order as part of a physical exam, at One Medical we take a measured approach. One of the main potential harms of annual physicals is what ensues from ordering unnecessary tests. Many tests involve radiation, potentially dangerous chemicals, or invasive procedures that carry significant risks. And all too often, testing leads to harmful treatments for conditions you may not even have, or for diseases you do have but that wouldn’t cause you any harm if they’d been left alone. Finally, with more testing comes increased anxiety and increased costs for you, the person who is ostensibly to benefit from all this testing.

So what can you expect at a One Medical physical? You can expect that we do our best to avoid all of this, and instead focus on getting to know you, which is immensely valuable, especially if you become ill in the future.

When Should I See My Health Care Provider, Then?

We believe strongly in the importance of seeing you whenever you feel the need. For that matter, we encourage you to spend time with your healthcare provider to review lifestyle issues, medical items you may have read in the news, catch up on vaccinations, and get a thorough checkup.

Your relationship with your primary care provider is one of the centerpieces of good health care, and although there may not (yet!) be data to support this view, we encourage you to spend quality time with your provider whenever you wish. Such visits contribute to your ability to lead a happier, healthier life. So no more guilt trips. We’ll be here for you whenever want to come in.

Here to keep you healthy. And informed.
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Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.