About the Discussion

@NEJM Ask the Authors & Experts: What To Do With the Annual Physical?

This discussion is about two separate Perspective pieces that were recently published in the New England Journal of Medicine regarding the value of annual physicals.

Improving Value in Health Care — Against the Annual Physical

The past few decades have seen numerous calls to eliminate the annual physical examination. In 1979, the Canadian Task Force on the Periodic Health Examination recommended “that the annual checkup, as practised almost ritualistically for several decades in North America, be abandoned.”

Toward Trusting Therapeutic Relationships — In Favor of the Annual Physical

Continued enthusiasm among both patients and physicians for the annual physical (also known as the periodic health examination) despite the dearth of hard evidence for its benefit raises the question of what drives its persistent appeal. Perhaps the answer lies in the less commoditized aspect of primary care — people’s desire or need to establish and maintain a close, trusting relationship with the doctor they consider their personal physician.

Perspective

Improving Value in Health Care — Against the Annual Physical

In 2013, as part of the Choosing Wisely campaign, the Society of General Internal Medicine recommended against annual preventive examinations in asymptomatic patients. Nevertheless, about one third of U.S. adults receive an annual physical (also called an annual preventive exam or periodic health exam) in any given year, and that trend has not abated (see graph). This ongoing practice is not surprising, since surveys reveal that the majority of both patients and physicians are strong proponents of the annual physical. In the face of this disconnect between expert recommendations and real-world practice, how do we move forward?

Perspective

Toward Trusting Therapeutic Relationships — In Favor of the Annual Physical

Much of the evidence for the effectiveness and value of a trusted doctor–patient relationship derives from the mental health literature, which has extensively documented the requirements and benefits of a therapeutic relationship. Benefits include enhancements in functional status, patient satisfaction, and adherence to medication regimens, valuable elements of all forms of medical care. Although there’s some evidence that such relationship benefits are also achieved in primary care, they’ve been harder to demonstrate in systematic reviews of the annual visit. Most available studies are observational, and the visits’ contents are too heterogeneous to permit investigators to draw conclusions.