Forget your annual checkup (redux)

This was the title of my second blog post, published on January 10, 2015. You probably never saw it. Here’s a revised version:

I had my last annual checkup in 2002. On that occasion my doctor informed me that my cholesterol was high. I’m not worried about mine and don’t believe in taking cholesterol-lowering drugs. Because I didn’t want to argue, I simply never went back for another checkup. It turns out, eliminating annual checkups is probably a wise decision for most of us.  

You probably get annual checkups because you think they might prevent you from becoming ill. I used to think that also. But I have since learned that reputable medical organizations agree with my stance. For example, one of the recommendations of the Society of General Internal Medicine’s “Choosing Wisely” campaign is “Don’t perform routine general health checks for asymptomatic adults” [my italics]—asymptomatic meaning you feel fine. Regularly scheduled general health checks, according to this group of doctors, “have not shown to be effective in reducing morbidity, mortality or hospitalization, while creating a potential for harm from unnecessary testing” [my italics again]. This conclusion was the result of studies that included nine trials of 155,899 patients.

After examining the records of 182,000 people from 1963 to 1999, the Cochrane Collaboration, an international group of medical researchers, came to the same conclusion. So did the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services. The Canadian guidelines have recommended against these exams since 1979.

Plenty of doctors say the same thing. For example, Dr. Ezekiel J. Emanuel, oncologist, and a vice provost at the University of Pennsylvania, says, “from a health perspective, the annual physical exam is basically worthless.” Dr. Michael Rothberg, a primary care physician and health researcher at the Cleveland Clinic, tries to avoid giving physicals. "I generally don't like to frighten people, and I don't like to give them diseases they don't have. If you get near doctors, they'll start to look for things and order tests because that's what doctors do." Dr.Ateev Mehrotra at the Harvard Medical School says annual physicals are a waste of money, costing us about $10 billion a year, which is more than we spend on breast cancer.

I've now gone for 22 years without an annual physical exam. Works for me.

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