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The Annual Physical is a Good Habit to Keep

It’s More About the Conversation than the Exam

By Julie Lindsey, MD January 19, 2015
Julie Lindsey, MD

Thinking about skipping your annual physical? Julie Lindsey, MD, a primary care doctor at Duke, explains why she gets an annual check-up, and why you should too.

As a primary care doctor, I can appreciate how busy people are. In many ways, what you do for yourself to stay healthy is more effective than what your doctor can do for you. And some of the tests typically associated with the physical are downright unpleasant. Then why bother with an annual exam, especially when there's no evidence to suggest it actually saves lives? Here's why.

A face-to-face wellness visit is the best time to connect with your doctor, establish trust, and let your preferences be known before serious illness hits.

The Physical Exam is Really an Annual “Wellness Visit”

Fortunately, most primary care doctors have moved away from the body cavity approach, and toward a more minimalist physical exam. Gone is the 'turn your head to the side and cough' screening for male hernias. The same goes for a rectal exam (unless you are bleeding or need a prostate evaluation).

The annual physical has evolved into an annual wellness visit. We have pared down the testing to what is recommended by evidence-based guidelines for each age group.  Rather than doing every test on every person every year, we determine who is at high risk and low risk, and adjust our testing toward that risk level. For example:

  • Pap smears are performed every 3-5 years;  
  • we don't do EKG screenings on people at low risk for heart disease; 
  • routine urine tests are only for certain conditions or symptoms.

In many ways, doing less is more complex and takes more time. It’s a lot easier to order a PSA test to screen for prostate cancer than to explain why it’s not helpful for some men to have this test. Each test merits a discussion of the risks and benefits. The  annual physical has become more about the conversation than the exam.

Staying Accountable for your Health and Lifestyle Habits

Even the most well-informed, health conscious person could have a blind spot when it comes to their own health. You don’t smoke and you exercise, but how much alcohol are you drinking? How are you managing your stress? Are you exercising as consistently as you think? 

I am a physician, but I still go in yearly for my wellness visit. Giving a doctor you trust a chance to offer some proactive health advice is invaluable. It’s more like an annual check in with your financial advisor than a car tune up. I provide my patients the accountability I want from my own doctor on important lifestyle and health behaviors.

The human exchange is the most important part of a wellness visit.

A Professional Opinion is More Valuable than Dr. Google

Keeping up with latest health recommendations is challenging, especially since many seem to change as frequently as the weather.

  • If you are 65, have you had your Prevnar pneumonia vaccine in addition to the Pneumovax?
  • Is your son getting his HPV vaccine?

Dr. Google is helpful, but a professional opinion is what you are paying for.

A very mundane but important task done at physicals is to manage and refill medications. It takes time to figure out which medicines people are taking, check for drug interactions and monitor for possible harms. There is a reason why prescription medications are not over the counter; a trained health professional must oversee their use.  It is better to do this face to face than on the fly through pharmacy or phone refill requests. Drug errors are preventable. And often, people can stop medications that are no longer needed.

The Sum of the Physical is Greater than its Parts

When it comes down to it, a physical exam is really a lot of little things that add up to a worthwhile trip to the doctor.

The human exchange is the most important part of the wellness visit.  It’s hard to provide comprehensive, humanistic care to people if we only see them when they are vomiting or in severe pain. If we know you when you are well, we will be better equipped to provide more satisfying care when you are ill. We will be more familiar with your health history and know you as a whole person. A face-to-face wellness visit is the best time to connect with your doctor, establish trust, and let your preferences be known before serious illness hits. 

People of All Ages Benefit in Different Ways

According to a Cochrane review in 2012, no lives are saved by physical exams. But, maybe saving lives is too high a bar to set. Promoting better health and well being is hard to measure. We do so many productive things at a physical that one would have to design the most complex, multi-faceted study to prove its effectiveness. 

Wellness visits benefit people of all ages in many different ways. It starts with the vaccines and guidance given at well baby and child checks, continues through the wonderfully complex teen visits, and plays a role in family planning and STD screening for young adults. The visits offer the opportunity to provide invaluable mental health and substance abuse counseling at all ages, and promote longevity and health through cancer screening and heart disease risk reduction after age 50.

The face-to-face annual wellness visit is a good habit to keep. Invest in yourself and get the most out of your health care. You are worth it! 

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