In years past, having patients come in for an "Annual Physical" was commonplace in any family medicine practice. As evidence has evolved, we have realized that the time and cost of this practice can be better used elsewhere. The actual physical examination component of a yearly visit has never been shown to be of utility. What is more debatable, is the need for routine testing or screening.
Screening is the practice of looking for disease in people without any symptoms. The idea is to find a disease or a modifiable risk factor for disease early on, where early intervention can prevent complications or offer an easier cure. Many screening tests are current recommended in Canada. Examples include but are not limited to:
- pap smears
- mammograms
- FIT testing (fecal immunochemical test)
- bone density
- PSA (prostate-specific antigen)
- cholesterol testing
- diabetes screening
You may be surprised to learn that for even these commonly recommended tests, the evidence of benefit is often questionable and almost no one needs them yearly. In this video, Dr. Mike Evans discusses some of these tests along with some others which are generally not recommended. The key with screening is making it individualized, based on your specific history, risk factors and values. This is why it is important to have a good relationship with your family doctor.
Although an "Annual Physical" may not be necessary, you should touch base regularly with your family physician, who knows you and your health history, to discuss and decide which test's you may benefit from. How often this discussion or "preventative health exam" should occur needs to be individualized. You can use the same opportunity to work on improving your lifestyle, which is usually much more beneficial to health than any test.
I see a common practice still occurring in some physician offices, where a receptionist gives a patient a lab requisition as soon as they book for a physical. This is bad medicine. Which tests to do needs to be a discussion between you and your physician. A single list of tests for every patient is not appropriate. This is an unnecessary cost to the system; but more importantly will lead to unnecessary testing, false positives and harm. More information about various screening tests and their indications can be found at choosingwisely.ca.
Below is information from Towards Optimized Practice about a change in the way we think about Cholesterol/Cardiovascular risk reduction. No one needs their cholesterol checked every year! (click on image to download/enlarge.)
