Ever since the days of William Osler, annual physical examinations with one’s doctor have been an accepted and expected part of health care. But recently the practice has come under some criticism. Given the dearth of studies showing that physicals lower the risk of death and hospitalization, some experts and organizations state that the annual physical should be abandoned.
I appreciate the effort here to question tradition and to consider if a commonly accepted practice truly has value. Nonetheless, I believe that in the appropriate patient population, annual physicals serve important functions. First, they ensure that people are up to date on their health maintenance measures. Screening for colon, breast, and cervical cancer is proven to save lives. In my work in hospice and otherwise, I have seen the tragedy of lives radically shortened by a failure to undergo appropriate cancer screening tests. In my physicals, I also review patients’ immunization records to make sure they have been appropriately vaccinated against tetanus, diphtheria, pertussis, shingles, pneumonia, flu, and hepatitis A and B. Doing so decreases their chance of suffering from these diseases and helps protect the surrounding community. Appropriate screening for sexually transmitted infections is also tremendously important. Through such screening, I have detected cases of HIV and syphilis, thereby enabling effective treatment and preventing the disease from spreading. Physicals are also a chance to see if a person has high blood pressure, elevated cholesterol, or type 2 diabetes. People with these conditions often do not present with symptoms, but left untreated they can result in debilitating outcomes such as heart attacks, strokes, blindness, and kidney failure. Finally, there is the issue of hip and vertebral compression fractures. By some estimates, nearly half of all women and 1/3 of men will have fragility fractures in their lifetimes. Such fractures increase the risk of death and can end or limit many people’s ability to remain independent. Effective screening and treatment for people with fragile bones can markedly lower their risk of fracturing their hips or spinal vertebrae.
Physicals are also occasions for addressing a person’s health lifestyle and habits. Smoking, excessive alcohol intake, and drug use can be identified and appropriate counseling given. I also assess how much a person is exercising and inquire into the state of their nutrition. Even if people already know the value of staying physically active and eating well, there is value in encouragement and reinforcement.
Physicals also allow me to obtain or review a person’s entire health history, as well as their family’s health history. This information is usually not addressed during other visits that focus on 1-2 specific problems. The process of reviewing a person’s complete health history helps put the issues a patient presents at other visits into a helpful context and framework.
Beyond all this, I view physicals as a time to get to know who a person is and what makes them tick. My task is to help people live longer and better, but what are they living for? Accordingly, as part of my social history, I usually ask patients something like “what gives meaning and purpose to your life?” or “what do you enjoy doing these days.” Having a stronger grasp of a person’s values allows me to be a better guide in making health decisions. And I believe there can be healing in simply sharing and receiving important, formative stories