You try your best to log eight hours of sleep each night, choose healthy food options when you can, and squeeze in a few hours of exercise each week. You’re young, and you think you’re generally healthy — and you probably are. But if you’re like 44 million American adults, you visit a doctor every year, just to be sure.
According to a survey from the Kaiser Family Foundation, a full 92 percent of Americans think that an annual physical is a cornerstone of general well-being, and around 62 percent report actually getting the check-up. But the ritualistic visit, which usually involves disrobing for a semi-arbitrary physical exam and giving away a few tubes of blood and urine, has been a point of controversy among medical professionals who question its utility.
The annual physical, or the periodic health evaluation, as it’s more formally known in the medical literature, dates back to the early 1900s, when the life insurance industry mandated that policyholders get yearly health screenings. Despite a lack of evidence showing any benefit of these check-ups, private physicians began promoting them, and the American Medical Association officially endorsed the practice in 1922. But only 50 years later, major players in the medical community started expressing misgivings about the whole tradition, and in 1979, the Canadian Task Force on the Periodic Health Examination recommended that “the annual checkup, as practiced almost ritualistically for several decades in North America, be abandoned.”
Then, in 2012, a major study published in the BMJ provided large-scale, concrete support for the elimination of yearly physicals. The findings: in the absence of symptoms, these check-ups don’t prevent disease, reduce disease burden, or decrease overall mortality rates. Like most physicians, in light of these findings, I don’t support the practice of yearly general health checks. In fact, the tests typically ordered during a yearly physical may actually do more harm than good. In asymptomatic people, any abnormality in a “routine” panel of laboratory tests has a high probability of being a false positive. Chasing these abnormalities (which are unlikely to be clinically significant) with follow-up tests can be expensive, anxiety-provoking, and may lead to invasive procedures, which have their own attendant risks.
But none of this is to say that you don’t need to see a physician unless you’re sick. It’s critically important that you have a primary care doctor, and setting up a visit just to establish care with one is not only acceptable, but encouraged. If you do develop a health issue, you want to have someone on call with whom you’ve built at least a preliminary relationship and who has already agreed to take part ownership of your health.
And although yearly physicals are unnecessary, there are times when you should see a doctor for routine screenings in the absence of any specific symptoms or concerns. For instance, the United States Preventative Services Task Force (USPSTF) recommends cervical cancer screening with pap smears every three years, and the American Heart Association recommends a comprehensive cardiovascular risk assessment every three to five years. You should therefore aim to see a physician who can perform these services (or can refer you to someone you will) roughly once every three years. After age 40, when some professional guidelines recommend every-other-year mammograms, women should start seeing a physician a bit more regularly.
Of course, if you’re pregnant, have a chronic medical condition, are on a prescription drug regimen, or have been advised by your physician to come in more frequently — for any reason — you should ignore these suggestions in favor of what your physician recommends. High-quality preventive health care should be tailored to your specific needs. Bottom line: ask your doctor how frequently she wants to see you. Most likely, it won’t be annually.