Examining the Annual Check-up
Over the past 18 months, many have had to – or elected to – forgo an annual physical exam. Does it matter? It’s a good question, one that’s not new to the pandemic era.
If an annual medical exam means lots of expensive diagnostic tests and invasive procedures, it may be time to put it to pasture. However, if it fosters a physician-patient relationship and allows for a partnership in prevention and treatment of diseases, then this alone may be a good reason to keep it.
So what are its pros and cons?
One of the downsides may be that it does not save lives. According to a Cochrane meta-analysis of 16 studies, an annual physical exam had no benefit related to mortality risk and morbidity (disease) risk.
The report went on to say that it did not have an effect on overall mortality, nor on cancer survival and/or cardiovascular mortality. The authors noted that primary care physicians may already be treating patients at high risk for diseases.
Another potential negative is that certain diagnostics, such as prostate-specific antigen screenings to test for prostate cancer, could be harmful.
The results of a meta-analysis presented at the European Cancer Conference show that routine screening for prostate cancer in the general, symptom-free male population may have more detrimental effects than benefits — a high PSA may lead to unnecessary invasive procedures, such as biopsies and prostatectomies (removal of the prostate).
Side effects could be impotence and infection and could result in hospitalization. The author acknowledged that there have been two large studies on PSAs, one touting the benefits and the other showing increased harm. This assessment may be the tiebreaker.
Not all diseases show symptoms, especially in the earlier stages. Examples include hypertension (high blood pressure) and chronic kidney disease. It is also an opportunity to discuss mental health. And, of course, there is the importance of lifestyle discussions.
Chronic Kidney Disease
Chronic kidney disease (CKD) causes more deaths than prostate or breast cancer. According to the Centers for Disease Control and Prevention, one in five patients with high blood pressure has chronic kidney disease, and most are undiagnosed.
Early to moderate stages of the disease without symptoms can only be identified through blood tests and urinalysis.
Detecting CKD early may be the key to halting its progress and preventing end-stage kidney disease resulting in dialysis. Without the annual exam, we may miss this opportunity.
Like CKD, there are frequently no symptoms to detect high blood pressure until it is too late. According to a study in the British Medical Journal, high blood pressure may be responsible for almost half of all heart attacks and a quarter of premature deaths in the U.S.
To reduce the risk of this “silent killer,” a study in the Annals of Internal Medicine suggests lifestyle modifications. In a meta-analysis, involving 54 small, randomized controlled trials, aerobic exercise had significant benefits in reducing blood pressure.
One of the most effective ways to know a patient is with a thorough discussion of history that identifies intangibles that may not show up in numbers, including mental health.
A presentation at the 26th European College of Neuropsychopharmacology Congress showed it is not what patients say, but how they say it that may be most important.
Short essays identified that those who were mildly depressed used significantly more verbs in the past tense than the present (100 versus 2.6 percent) and used less complex sentences, compared to the healthy control patients.
Ultimately, the success of an annual medical checkup is the physician’s approach. With a strong focus on a thorough history, rather than a predominance of diagnostic testing leading to invasive procedures, there is little downside.