Annual Exam Abandoned by Docs, Desired by Patients
Mon May 6, 5:38 PM ET
By Charnicia E. Huggins

NEW YORK (Reuters Health) - The idea that individuals should undergo annual medical check-ups was abandoned by American health professionals several years ago, but many patients still think that such exams are necessary, new study findings show.

These patients may be unaware that annual comprehensive physical examinations have been shown to have little or no value and have thus been rejected by the American Medical Association, the US Public Health Service and various other medical organizations.

These groups instead recommend that healthy men and women undergo regular specific screening tests such as Pap smears, mammograms and fecal occult blood testing, which have been proven beneficial in detecting cervical, breast and colorectal cancer.

"There is a need to educate the public about the value of periodic health exams and current recommendations for specific preventive health services," study author Dr. Robert J. Anderson, of the University of Colorado Health Sciences Center in Denver, told Reuters Health.

"In terms of maintaining health and preventing disease...annual exams have not been shown to be of value," he added.

Anderson and his colleagues surveyed 1,203 individuals from Colorado, Massachusetts and California, and found that two thirds of the respondents believed that annual physicals are a necessary component of routine medical care.

In Colorado, for example, more than 9 out of every 10 respondents desired "head-to-toe" examinations including heart and lung exams and testing of their reflexes, the investigators report in the May 7th issue of Annals of Internal Medicine. These individuals also expected doctors to ask them about their alcohol and drug use, diet and exercise.

Further, patients were more interested in blood tests for kidney, liver, or thyroid function--none of which are currently recommended--than they were in tests of proven value, such as mammograms, sigmoidoscopies and other types of cancer screenings, the report indicates.

"There is need for better public education about changing their expectations from tests and procedures of unproven value to those of proven benefit," Anderson said.

The researchers did note, however, that the participants were less likely to desire an annual exam and various tests if they were informed of the associated charges.

For example, the percentage of individuals who wanted an annual exam decreased by nearly half--from 63% to 33%--when the patients were notified of a $150 charge. Similarly, the percentage of women who wanted a Pap smear dropped from 75% to 38% and the percentage of men who wanted a prostate cancer (news - web sites)-screening test dropped from 66% to 43%.

"The public's desire for annual exams and testing...decreases if the public has to personally pay for the test," Anderson said. He believes that this finding may have implications for "channeling patients into wise use of tests."

Yet, Anderson added that annual exams are not completely useless and may have value, particularly when it comes to "establishing good relationships, mutual trust and confidence" between doctors and patients.

Dr. Christine Laine, senior deputy editor of the journal in which Anderson's study is published, agrees.

"The regular laying-on of hands and not a needless ritual if it fosters trusting clinical relationships and ensures that patients receive effective counseling and preventive interventions," she writes in an editorial accompanying the study.

SOURCE: Annals of Internal Medicine 2002;136:652-659, 701-703.