A popular feature in Good Times magazine is “Your Health Questions,” in which we find experts to answers questions submitted by our readers about health, nutrition, and well-being
By Wendy Haaf
Photo: iStock/dolgachov.
Q. Do I really need a medical exam every year? Or is it true that an annual checkup is no longer recommended?
A. It’s true that an annual visit to your doctor for a top-to-toe physical exam plus a raft of routine tests is no longer recommended, but that’s not to say that you should see your doctor or nurse practitioner only if you’re sick.
Before we get into when you should touch base with your primary care provider, however, a word about why the annual checkup has fallen out of favour. In short, research has repeatedly found no evidence that the practice keeps people healthy longer or extends their lives. What’s more, doing screening tests in healthy people with no symptoms of or risk factors for a particular condition could do more harm than good: for example, an incorrectly interpreted electrocardiogram could trigger a referral for a procedure that causes a heart attack or death in two patients out of every 100.
“Moving away from this idea of annual health exams for everybody was done very thoughtfully and based on evidence,” stresses Dr. Joshua Tepper, a family physician and the president and CEO of Health Quality Ontario, an organization that advises the province on how to maintain and improve the quality of health care. “This is actually about following what the science says and making sure I’m making respectful use of your time and not putting you at risk with things you don’t need.”
But that doesn’t mean abandoning visits for preventive health care; it means doing them selectively, on a schedule tailored to you as an individual patient. “Basically, we’re talking about periodic health visits,” says Dr. Neil Bell, a professor in the Department of Family Medicine at the University of Alberta’s Faculty of Medicine & Dentistry and a former member of the Canadian Task Force on Preventive Health Care. “Depending on your age, your sex, your health conditions, and various risk factors, you come in at intervals that reflect your needs.”
Some screening tests, for example, are often recommended less frequently than once a year. For example, while Pap smears were once done annually, our understanding of cervical cancer has evolved: healthy women with no history of abnormal results need to have the test only every three years and can stop having them after age 69 (provided they’ve had three consecutive negative tests in the previous decade). You and your doctor can discuss if and when screening tests for conditions such as high blood pressure, diabetes, high cholesterol, breast cancer, colon cancer, osteoporosis, and abdominal aortic aneurysm are appropriate for you.
On the other hand, in many situations, your care provider may want to see you more often than once a year for shorter, more targeted visits, say, to monitor and manage chronic conditions such as high blood pressure and diabetes, to determine whether a medication you’ve started is having the desired effect, or to help you work on modifying risk factors such as obesity and smoking. Some physicians might also suggest coming in more often than annually if you’re going through a difficult time—in fact, according to Tepper, one advantage of abandoning the term “physical” is that it may help make people more comfortable bringing up mental health concerns such as stress and anxiety. Another potential plus of moving to a personalized versus a calendar schedule is that people may be less apt to save up concerns and instead check in when needed.
Tepper views the new, improved approach to health exams as being on a par with developments such as minimally invasive operations. “Nobody says, ‘I’d rather have my gallbladder taken out the old way, with the big incision and many days of recovery,’” he observes. “We should be as pleased about this type of knowledge advancement as we are about other advances.”
