GlassHospital

Demystifying Medicine One Week at a Time

The Best Laid (Follow-Up) Plans

My friend’s 92 year-old grandmother goes to see her eye doctor.

“Everything looks great,” he reassures her.

“When should I come back?” she wants to know.

“Two years.”

Now that’s positive thinking.

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This funny story raises an interesting question. When should you go back to see the doctor?

Turns out like a lot of things in Medicine, it’s a bit of hocus pocus mixed with tradition. Perhaps with a tiny pinch of scientific evidence thrown in.

If you have no chronic medical problems (e.g. diabetes, high blood pressure, etc.), do you see your doctor once a year?

Should you?

There’s debate about the value of annual physicals. I fall clearly into the middle of the road, “Get ’em if you want ’em” camp-but I don’t think they’re at all mandatory. In my experience, however, there is some clear psychological benefit to people of a certain mindset: Getting an annual physical makes them dutifully able to check something off their list and perhaps allay anxiety for another year.

Ironically, it’s usually the healthiest people (i.e. those least in need of medical care) who report for annual physicals. Hmmmm, maybe there’s some correlation there.

The extremes of the annual physicals question [from the doctors’ camp] are:

  1. Absolutely. It’s a great chance to catch up with your patients and discuss new health issues that arise, take advantage of evolving medical science, and achieve age appropriate preventive care. [Don’t call it ‘preventative’ care.]
  2. Since there’s no medical evidence for the annual physical itself (and under current health care financing, it’s poorly reimbursed), scrap the idea.

As far as patient viewpoints, there are also two camps:

  1. It’s a must. I swear by it, and could tell you about my uncle/cousin/brother/neighbor/fill in the blank who had some horrible thing discovered at his/her annual physical.
  2. I only go to the doctor when something is a tad amiss. “If it ain’t broke, don’t fix it.”

Most experts agree that scientific evidence in favor of physicals is downright skimpy. Nevertheless, research shows that about two-thirds of surveyed adults think there’s value in an annual physical with a doctor. This makes it seem as though it’s a habit that will die hard. And advocates of behavior change suggest using the annual visit as a means of improving health through diet and exercise–since there’s so little time to do that at other visits.

There are a few key evidence-based age appropriate vaccinations and screening tests that are recommended by multiple authorities. To learn about those, you can read about them, or use my colleague Dr. Nundy’s online checklist.

Of course, you can always visit the doctor, too. Just don’t be put off if we tell you to come back “when you feel like it.”

7 Comments

  1. You didn’t refer to age of patient as a factor in whether an annual physical is indicated. I know that many of the aspects of an annual have been scotched: chest x-ray, exam for hernia, EKG and more. My Dr. seems to rely on what I report as a “problem” in order to proceed. Plus looking at various lab results. Of course I should exercise more which doctor visits and lab tests can’t do for me!

    • glasshospital

      May 20, 2010 at 6:38 pm

      When I started writing this post, I originally had it “if you’re 60 or under,” which implied that those over 60 should be getting annual visits. The truth is, though, it’s not any different with regard to the evidence. If you’re lucky enough to escape chronic conditions, annual physicals don’t add a lot of value. Thanks for your comment!

      John

  2. I’m just an MS1 (almost MS2!) so my patient experience is somewhat limited- but my school has a preceptor program, and very few of the patients I’ve seen have come in for full physicals- I think in the 15 or so times I’ve been, I’ve seen 1 physical start to finish. This is in a family medicine practice. Everyone else is there for a problem focused visit. At the start of the precepting experience, I’d thought it would be mostly physicals.

    • glasshospital

      May 21, 2010 at 10:42 am

      Sounds like you’re surprised by the fact that most visits are “sick” visits or “problem-focused,” rather than anticipatory or preventive. Is that good or bad in your experience, or just different?

      Thanks for the comment. Keep up with the style–it no doubt helps a lot to have some healthy, non-medical hobbies (did you say obsessions?).

  3. I am 61, and recently had an annual mammogram because it was convenient and inexpensive. I was shocked to discover that I actually did have breast cancer (stage II), and that I needed to start treating it immediately. I am taking meds (Femara), and will have surgery in a few months. I usually did have annual mammograms, but did not take them all that seriously until now.

    I do see my internist regularly, and I think she is excellent with regard to monitoring my health. I see her 1-2 times a year unless I have some reason to see her more often.

  4. Here’s my take…and I’m 60+. I had a MI at 58, primarily because I wasn’t making regular visits, based on my family’s ugly cardiovascular history. So, 2 angioplasties and 2 stents later, I decided it was time to take control of my health if I wanted to live a “long” life. I now routinely visit my cardiologist every 6 months, and now have a relationship with an internist that I also visit every 6 months. The internist first wanted me to see her every 3 months, but we “compromised” on 6, so I’m basically seeing a physician every 3 months. Also see a neurologist every 3 months for another issue that has come up. One good thing is that my internist really keeps me up to date on all the required “age” specific testing that one needs. And we do an annual physical. I am now a much healthier, attractive, and happier person than I was at 58, and I’m 5 1/2 years post MI. Even my cardio is surprised at how well I’m doing!

    So yes, there is something to be said for those routine IM visits…they keep one “in line”, healthwise. Too bad it took me so long to learn that lesson.

    Really enjoy your blog.

  5. The way I see it, if we require our cars to have yearly inspections, we should get them too. We are our own most important vehicle.

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