I would argue, then, that glib dismissal is misguided. Rather, the safest and most promising option in the absence of answers to all relevant questions, is to optimize the annual exam, not discard it. There is no need for a battery of perfunctory procedures or ridiculously low-yield lab tests. But these could be replaced with a review of lifestyle practices and use of relevant preventive services; with time for pertinent, customized lifestyle counseling; and with attention to whatever happens to be on a patient’s mind, building that very thing to which modern, evidence-based medicine may pay all too little attention: a relationship. A fundamental human connection.Read the whole thing.
The writer makes some good points, as does Dr. Emanual.
The problem has long been payers requrements for certain items to be performed during a physical that have not been changed or challenged in years, and make alot of what is done at a physical an anacronistic exercise. The examination of every organ system is not very helpful and of low yield in most circumstances, but necesary to document to satisfy parors. Medicare, to its credit, allows a annual exam that actually does not require any actual examination of the patient other than vital signs and some assesment of cognitive status.
The writer is correct that there are items that are very pertinent to ones health that it is helapful for the physician to discuss with our patients, and this is generally what is done at a annual exam. Lab testing and EKGs may be unnecessay to a large degree, but patients often perceive the lack of this testing to be a sign that the doctor is less than thorough in their evaluation.
If every recommendation of the Cochrane Collaboration is to be practiced, physicians will do little else than tell people to lose weight and quit smoking. They seem to see no value in any preventative medicine and are too concerned about the anxiety of testing.
In defense of an annual physical, and to quote a famous cardiologist (not me!), "You can't find what you don't look for and you only look for what you know".
In my 37 years of practice I have seen the typical age of someone thought to be elderly (for medical purposes) climb from 65 to 85-95. Did this happen by devine intervention or did some other form of intervention occur...e.g., identification and treatment of diabetes, hypertension, obesity, inactivity, anemias, not to mention various cardiac maladies. How many early GI malignancies have been put to rest by various forms of regular screening. The list is endless.
Those of us who take care of individuals and their families will lose no sleep by continuing to do what doctors are supposed to do. I still place my trust in HIppocrates and Maimonides. As for Emanual, let him testify before Congress and pontificate in the clouds.
It's a weak defense at best. For example, unless you have a concierge doctor (and even then maybe not), what are the chances that the doctor who answers your call at 3 AM will be the doctor you saw for you annual checkup?
And if you are admitted to a hospital, you will be cared for by a panel of rotating hospitalists, not the doc who knows you.
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