Most patients view the annual physical exam as a highly choreographed series of bodily pokes and prods, followed by a litany of studies including EKGs, imaging scans and blood tests, all crammed into thirty minutes or less. It’s no wonder that many health policy commentators have concluded the annual exam is a dinosaur deserving of extinction, poorly adapted to the fast pace of modern medicine.
But just as paleontologists piece together fragments of bone scattered across a landscape, we believe a well-designed annual exam yields clues that contain a wealth of value to both patient and physician alike.
Medical reimbursement rewards procedures and productivity, and a properly done physical exam often yields neither. At our clinic the annual exam is ninety percent discussion and ten percent examination, and takes about an hour. Most patients come in wondering what we are going to talk about for that time, and leave remarking that they did not realize how much they had to share.
We agree with health policy experts that the clinical utility of most screening tests and labs (EKGs, chest X-rays, yearly checks of thyroid, blood counts, and cholesterol, among others) comprising the typical physical exam is low. It’s why we don’t do perform them unless patients have underlying health problems (thyroid disease or high cholesterol, for example).
What we do emphasize during the annual exam is a comprehensive overview of the patient’s health.
As many physicians have joked for decades, if patients stopped smoking, started exercising, drank less alcohol and ate fewer calories, most of us in the health care community would be unemployed. Itʼs usually only during the annual physical exam, though, that those very habits — and many others – get any attention.
Taking time to focus on patientsʼ lifestyles has real value. Doctors who advise their clients to quit smoking, for example, can double the quit rate of smokers. Similarly, doctors who recommend exercise to their sedentary patients can encourage them to be more physically active. And lifestyle diseases – diabetes, obesity, hypertension, and cardiovascular disease – are what ail our country today.
A host of other questions, some basic (how well do you sleep) and some more delicate (how is your sex life) provoke additional discussion.
Finally, we ask questions designed to reveal diseases that patients might not know they have, especially if symptoms are subtle. Our standard cardiopulmonary inquiry (“Any chest pain, shortness of breath, irregular heartbeat, or frequent cough?”) has on occasion brought new findings to the forefront. Additionally, many patients fail to properly rank the relative importance of symptoms. Exertional breathlessness that is new but mild might be overshadowed by a patient’s concern about back pain that is keeping her awake at night.
Todayʼs internet-based research tools can yield a wealth of content on many topics, including health. Sadly, much of it is poorly written, solely commercial, or just plain incorrect. We use the annual exam as a platform to educate patients about new recommendations — that yearly pap smears and mammograms, for example, are no longer recommended, but that flu shots and whooping cough vaccinations are now advised for all age groups.
Understanding what patients value, and how they want to achieve their health goals, is a fundamental part of being a doctor. Eliminating the annual physical hampers the collaborative process between physician and patient, and diminishes the relationship for both parties.