There is no shortage of publications, studies, and opinions recommending annual physicals be eliminated as a staple of preventative care and wellness. In fact, the Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. Despite randomized trials going back to the 1980s not supporting it, annual physicals continue to be a ritual for 44 million Americans. According to a Kaiser Family Foundation poll, 92% Americans say it is important to get an annual head-to-toe physical exam and 62% said they went to the doctor every year for their exam. Research shows that you only need go to the doctor if something is wrong or if it’s time to have an important preventive test like a colonoscopy. Healthy, asymptomatic adults should stay home.
The popularity of the procedure is largely due to the peace of mind individuals feel after going to the doctor and the financial incentives primary care physicians have in seeing patients (more money). Since most preventative care is covered under the Affordable Care Act, the barriers stopping someone from getting an exam are minimal. Also, some people believe the benefits of seeing a doctor annually go beyond health impacts. Specifically, in order to build a relationship with a physician before it is really needed, there needs to be regular interaction between the parties. Annual physicals allow for a relationship to grow, and some would argue that these benefits are hard to quantify in studies.
If an annual physical goes beyond the basics of a biometric screening (additional tests, more peace of mind, opportunities for patient-physician relationship building, etc.) but still is questioned heavily by the academic community, why do biometric screenings remain part of so many corporate wellness programs? Some people point to research showing proof that screenings work, but critics will show that these studies are often conducted or funded by biometric screening vendors who have a financial stake in their alleged efficacy.
Many of the renowned critics of wellness programs (the naysayers) focus their energy on biometric screenings because the “health screenings built into the programs encourage overuse of unnecessary care, pushing spending higher without improving health.” At least annual physicals have the opportunity for patient-physician relationship building; biometric screenings do not even offer that. Also, employees who truly want a more comprehensive physical exam will still get one, which results in duplicative expenses for the employer.
Dr. Michael Rothberg, a primary care physician and health researcher at the Cleveland Clinic and advocate of skipping annual physicals in healthy adults, says he replaces the physical aspects of the exam with his patients who want an annual physical. Rather, he focuses instead on talking to them about their dietary and exercise habits, possible risks, age-appropriate vaccinations, and any screening tests they may need.
The future of successful wellness (the kind the quiets all the naysayers) has to be in lifestyle management and prudent use of healthcare resources. Employers need to use evidenced-based decision making, which means cutting out the costly and unnecessary biometric screening.