Annual Medical Checkup: The Not So Routine Physical Exam

by Food and Drug Administration (FDA)

The annual medical checkup, once a cornerstone of American health care, is fading into medical history. Like Mercurochrome and the iron lung, the routine annual physical for people who aren't sick came and went in less than a century — replaced by an approach to periodic health screening based on a new awareness of the importance of risk analysis and targeted preventive services.

That may sound like impersonal, high-tech medicine, but it isn't. Today's far-from-routine health checkup is grounded on a highly personalized concept: the idea that every individual is unique, that each of us has a medical history and lifestyle that strongly influence how healthy — or unhealthy — we are now and may be in the future.

Something Old, Something New

Today's health checkup draws on the best aspects of horse-and-buggy medicine, back when the family doctor was likely to be a long-time neighbor and friend. But it adds the product of research on factors that influence a person's risk of serious illness — factors that range from family history to eating habits. Using that knowledge, physicians can zero in on specific preventive strategies for individual patients — selecting those, like smoking cessation or nutrition counseling, that have a good chance of helping the patient avoid serious illness or injury and omitting others, such as chest x-rays, that are of little or no benefit to healthy people.

At a time of high and rising health-care costs when health insurance providers are reluctant to cover the cost of routine checkups for people who aren't sick, moves to forego procedures of little or no value can save enormous amounts of money. At the same time, physicians are generally on the lookout for ways to make their limited time with individual patients as helpful as possible. Getting away from routine tests of dubious effectiveness and devoting more time to patient counseling that can pay off in better health have a powerful appeal for many health-care professionals.

The routine physical became firmly rooted in standard American health care almost half a century ago. In 1947 the American Medical Association recommended that every healthy person 35 or older pay a yearly visit to the doctor to get a battery of tests, a head-to-toe physical examination, and a conference to discuss anything that might concern either doctor or patient. That was a bold move on the part of organized medicine: People were being advised to see their doctors not just when they were sick, but when, presumably, they were well.

The idea was radical, but it wasn't new. The annual physical for seemingly well patients had been proposed at an AMA meeting as early as 1900. And a lot earlier still — as long ago as the 25th century B.C. — Chinese Emperor Huang Ti wrote: "The superior physician helps before the early budding of the disease," not when it has already developed. The modern health checkup takes that ancient wisdom one giant step further, however. Physicians today are able not just to offer help before disease develops, but to keep some diseases and disabilities from occurring in the first place.

For example, counseling a patient to quit smoking — better yet, persuading a youngster never to start — is a prime example of disease prevention that is now seen as a valuable part of a periodic health exam. Tobacco smoking contributes to 1 out of every 6 deaths in the United States, including 130,000 deaths each year from cancer, 115,000 from coronary artery disease, and 60,000 from chronic obstructive lung disease.

The same kind of hard statistical evidence makes the case for physicians helping their patients cut down on fat intake, use seat belts, curb alcohol consumption, get more exercise, and otherwise adopt a lifestyle that can lower the risk of disease and injury.

But a number of questions face physicians and health organizations, as well as patients who want the periodic health checkup to be as beneficial as possible. Which tests, what sort of counseling, and what immunizations or medicines are most effective in preventing or minimizing serious illness? Which ones are appropriate for some patients but not all, for some age groups but not others? Which should be carried out every year, every three years, five years? How do you decide that a test is no longer needed or, conversely, that it ought to be done more often? The answers to such questions are less than certain, but patients and physicians alike have a good deal more to go on than they did a decade ago.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.