Ever since the days of William Osler, annual physical examinations with one’s doctor have been an accepted and expected part of health care. But recently the practice has come under some criticism. Given the dearth of studies showing that physicals lower the risk of death and hospitalization, some experts and organizations state that the annual physical should be abandoned.
I appreciate the effort here to question tradition and to consider if a commonly accepted practice truly has value. Nonetheless, I believe that in the appropriate patient population, annual physicals serve important functions. First, they ensure that people are up to date on health maintenance measures. Screening for colon, breast, and cervical cancer is proven to save lives.
In my work in hospice and primary care, I have seen the tragedy of unnecessary suffering and premature deaths caused by a failure to do appropriate cancer-screening tests. In my physicals, I also review patients’ immunization records to make sure they have been appropriately vaccinated against tetanus, diphtheria, pertussis, shingles, pneumonia, flu, and hepatitis A and B. Doing so decreases their chance of suffering from these diseases and helps protect the surrounding community. By screening for sexually transmitted infections I have detected HIV and syphilis, thereby enabling people to be treated at an early stage of the illnesses and preventing their spread into our local population.
Physicals are also a chance to see if a person has high blood pressure, elevated cholesterol, or type 2 diabetes. People with these conditions often do not present with symptoms, but left untreated they can result in debilitating, costly outcomes such as heart attacks, strokes, blindness, and kidney failure. Finally, there is the issue of hip and vertebral compression fractures. By some estimates, nearly half of all women and 1/3 of men will have fragility fractures in their lifetimes. Such fractures increase the risk of death and can end or limit many people’s ability to remain independent. Effective screening and treatment for osteoporosis can markedly lower individuals’ risk of suffering hip or vertebral compression fractures.
Physicals are also occasions for addressing a person’s health habits and lifestyle choices. Smoking, excessive alcohol intake, and drug use can be identified and appropriate help provided. As part of my social history, I assess how much a person is exercising and inquire into the state of their nutrition. Even if people already know it is good to be physically active and eat well, there is value in encouragement and reinforcement.
Physicals are a dedicated time for obtaining or reviewing a person’s entire health history, as well as his or her family’s health history. This information is usually not addressed during other visits that focus on 1-2 specific problems. Updating and discussing a person’s complete medical history helps put issues presented at other visits into a helpful context and framework.
Beyond all this, I view physicals as a time to get to know the patient as a person and what makes him or her tick. My task is to help people live longer and better, but what are they living for? Accordingly, as part of my social history, I usually ask patients something like “what gives meaning and purpose to your life?” or “what do you enjoy doing these days.” Having a stronger grasp of a person’s values allows me to be a better guide in making health decisions. And I believe there can be healing in sharing and receiving important, formative stories.
James Marroquin is an internal medicine physician who blogs at his self-titled site, James Marroquin.
