Vinod Kurup

Hospitalist/programmer in search of the meaning of life

Annual Waste of Time?

Another interesting article in the Times today. Lo and behold, the annual physical exam is useless. Shocking, huh? Well, no - not really. The first questions about the annual physical cropped up 20 years ago and recent studies have only confirmed these initial doubts.

So, do I perform annual physicals? Yup. Why? A few reasons…. As a relatively young doc, I think it’s important to examine LOTS and LOTS of normal patients in order to get a firm sense of what’s normal and what’s abnormal. And even if I were 100% confident in my physical exam, I would still want to keep those exam skills sharp.

The annual physical is also a great time, if not the only time, to discuss preventive care with patients. Acute care visits are already rushed and sick patients aren’t the most receptive listeners.

Patients in my community are underserved as it stands - getting rid of annual physicals would only contribute to patients getting lost in the system.

Finally, and most importantly, performing annual physicals makes me look like a doctor. Patients expect annual physicals and I’d look like a quack if I didn’t perform them, regardless of how much science is backing me up. This is one of those classic “Art of Medicine/Science of Medicine” intersections. In order to be able to practice the Science of Medicine effectively, we need to compromise on the scientific purity a bit, for the sake of the Art of Medicine.

“I still listen to everyone’s heart,” said Dr. Stewart Rogers, an internist at Moses Cone Hospital in Greensboro, N.C. “Why pick that fight? Why try to explain 10 years of evidence-based medicine so the patient will understand why I didn’t do that test? The reason to listen to hearts is that it establishes our priestly majesty when you tell them about smoke alarms.”

That being said, I do try to explain to patients that not all tests are necessary and can in fact be harmful, but I’m not dogmatic about it.