Request to Join
has invited you to join this group
has invited you to join this group
Professor of Medicine, Harvard Medical School; Physician of the Medical Service at MGH
Associate Professor, Department of Health Care Policy at Harvard Medical School
Professor of Medicine at University of Colorado School of Medicine
Editor-in-Chief of Annals of Internal Medicine
Professor of Medicine, Division of General Internal Medicine at University of Alabama at Birmingham
Clinical Innovator and Physician at Iora Health
Associate Chief of Staff for Research at Minneapolis VA Medical Center
Chief, Department of General Medicine/General Internal Medicine at NHO Nagasaki Medical Center
Internist, Writer, Clinical Assistant Professor, Zucker School of Medicine at Hofstra Northwell
Practicing family physician. Patient advocate. Physician leader. Professional Parent. NE Patriots fan
Deputy Registrar at College of Physicians and Surgeons
Assistant Professor of Family Medicine, University of Ottawa, Canada, Family Physician
Internal Medicine Specialist at Coastal Medical, Inc.
Adult-Gerontologcal Nurse Practitioner
Senior Counsel and Medical Director at Guttman, Buschner, and Brooks PLLC
Adjunctive Professor, Faculty of Medicine at University of Ottawa
NPPHC (Primary Health Care), Bruyere Academic Family Health Team at University of Ottawa
Medical Student at Harvard Medical School; Costs of Care team; Pragmatic optimist
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.
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.”
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.
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?
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.
Professor of Medicine, Harvard Medical School; Physician of the Medical Service at MGH
Associate Professor, Department of Health Care Policy at Harvard Medical School
Professor of Medicine at University of Colorado School of Medicine
Editor-in-Chief of Annals of Internal Medicine
Professor of Medicine, Division of General Internal Medicine at University of Alabama at Birmingham
Clinical Innovator and Physician at Iora Health
Associate Chief of Staff for Research at Minneapolis VA Medical Center
Chief, Department of General Medicine/General Internal Medicine at NHO Nagasaki Medical Center
Internist, Writer, Clinical Assistant Professor, Zucker School of Medicine at Hofstra Northwell
Practicing family physician. Patient advocate. Physician leader. Professional Parent. NE Patriots fan
Deputy Registrar at College of Physicians and Surgeons
Assistant Professor of Family Medicine, University of Ottawa, Canada, Family Physician
Internal Medicine Specialist at Coastal Medical, Inc.
Adult-Gerontologcal Nurse Practitioner
Senior Counsel and Medical Director at Guttman, Buschner, and Brooks PLLC
Adjunctive Professor, Faculty of Medicine at University of Ottawa
NPPHC (Primary Health Care), Bruyere Academic Family Health Team at University of Ottawa
Medical Student at Harvard Medical School; Costs of Care team; Pragmatic optimist