What's the Prognosis for Annual Medical Checkups?

It used to be that visiting your doctor for an annual medical exam was the responsible thing to do. Good doctors were expected to pepper their patients with postcards reminding them it was checkup time, and good patients were expected to comply.

Evidence-based healthcare has changed all that. Studies show that the traditional top-to-bottom annual physical for healthy adults is largely a waste of time and healthcare dollars; it is too "low yield." So now the American Medical Association and other professional groups do not recommend the practice. Instead, they say medical care should be individualized according to a patient's age, health, and specific risk factors.

Traditions die hard, as is evident in a recent Gallup Poll* that shows 92% of Americans think it is important for people to have a routine medical checkup each year. When the question was phrased slightly differently, 95% say it is important for people their own age to have such a checkup. Young adults are as likely as seniors to believe this.

Not only do most people espouse this ideal; they live it. Nearly 8 in 10 Americans (78%) report that they personally had a routine exam in the past year.

There is a slight difference on this by gender: 83% of women versus 73% of men say they have had a routine checkup. This gender gap is primarily evident among adults under 50; 79% of women, but only 66% of men have had one. Men and women aged 50 and older are about equally likely to have had one.

These questions were asked as part of Gallup's annual health survey, which also includes a number of questions about respondents' own health and lifestyles. Speaking directly to the AMA's doubts about the value of annual physicals for healthy adults, people who describe their personal health as "excellent" or "good" are no less likely than those whose say their health is either "fair" or "poor" to have had a routine exam in the past year.

Although smokers have specific risk factors because of their habit, Gallup finds no significant difference in the percentage of smokers and nonsmokers who have had a routine checkup in the last year.

Also, those who are describe themselves as overweight are no more likely than those who say their weight is about right to have had a routine medical exam.

While there is some relationship between household income and the likelihood of having had a routine exam, the likelihood varies a great deal by health insurance coverage. More than four in five insured Americans have had a routine medical checkup, compared with less than half of those without any insurance.

Bottom Line

The AMA and other professional groups may be exhibiting poor bedside manners in recommending against annual checkups. With so much emphasis on diseases and health risks in medical news, maybe patients have a legitimate need for annual reassurance that they are still OK.

That's the feeling of some doctors who argue the annual physical serves a vital function in nurturing the doctor-patient relationship -- what Dr. Patrick G. O'Malley of Walter Reed Army Medical Center called the "less tangible benefits" of annual exams in a June WebMD Medical News article.

O'Malley is hardly alone. In a recent study reported in the Archives of Internal Medicine, 94% of primary doctors surveyed believed that annual physical exams improve the doctor-patient relationship and give doctors a unique opportunity to counsel patients on preventative healthcare.

But the healthcare train seems to be speeding in a different direction, albeit one that may provide a suitable compromise. The new approach to annual exams is called the "periodic health exam" or "PHE." The PHE is supposed to be regular (though not necessarily annual) and relies on a detailed family health history to tailor care to a patient's needs. The U.S. Surgeon General recently designated Thanksgiving 2005 as the second annual "National Family History Day" -- hoping that people will take advantage of the assembly of relatives to chronicle their families' health history. Although PHEs appear to be the wave of the near future, it also appears there could be some resistance from patients and doctors who remain attached to the old system.

*Results are based on telephone interviews with 1,011 national adults, aged 18 and older, conducted Nov. 7-10, 2005. For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error is ±3 percentage points.