Regarding the Jan. 11 Ezekiel J. Emanuel column “ That annual physical? Skip it”: Isn’t Dr. Emanuel being a bit cavalier? Does he really want people to skip their annual physicals? Isn’t he an oncologist? Does he really think we can do effective cancer screening without routine wellness visits? All a waste? No lives saved? Too expensive?
I am am a primary care physician, and I do agree with Emanuel that much of the actual physical exam is of limited value. And, let’s be honest, some parts are downright unpleasant.
Fortunately, most primary care doctors have moved away from the overkill body cavity search approach toward a minimalist type of exam. Gone is the turn your head to the side and cough screening test for male hernias. And, by all means, just say no to a rectal exam unless you are bleeding or need a prostate evaluation. We have pared down the testing done at physicals to what is recommended by evidence-based screening guidelines for each age. The annual “physical” has become the annual “wellness visit.”
I find it odd for Emanuel to say that he would get immunizations and tests like a colonoscopy but not go in for a doctor visit. The “physical” is precisely when we discuss, order and administer these preventative measures supported by evidence.
I am a physician, but I still go in yearly for my own wellness visit with my personal physician. Giving a doctor we trust a chance to offer some proactive health advice is invaluable. It’s more like an annual check-in with your tax adviser than a car tune-up.
A “physical” is really a lot of little things that add up to a worthwhile trip to the doctor. Please come in for routine care and not just when acutely ill. It’s really hard to provide good comprehensive humanistic care to people who come in only when they are vomiting or in severe pain. If we know patients when they are well, we will be familiar with their health history and provide better care.
Maybe saving lives is too high a bar to set for a “physical.” Promoting better health and well-being is hard to measure. We do so many productive things at a physical that one would have to design the most complex study to prove efficacy.
Wellness visits benefit people of all ages – from vaccines and guidance given at well baby and child checks, to the wonderfully complex teen visits, to family planning and STD prevention for young adults, to mental health and substance abuse counseling at all ages, to cancer screening and cardiovascular risk reduction after age 50.
Let’s turn the scalpel of evidence-based cutting to many of the unnecessary invasive procedures we perform in our tertiary health care system. The face-to-face annual wellness visit with a doctor is a good habit to keep. Invest in ourselves. We are worth it!
The length limit was waived to permit a fuller response to the column.