Why I Don’t Recommend An Annual Physical

Integrative Medicine Doctor By Amy Shah, M.D.
Integrative Medicine Doctor
Dr. Amy Shah is a double board certified MD with training from Cornell, Columbia and Harvard Universities. She was named one of mindbodygreen's Top 100 Women In Wellness to Watch in 2015 and has been a guest on many national and local media shows.
Why I Don’t Recommend An Annual Physical

If you pay a visit to your primary care physician every year, you know what annual exams are like: you take time off work, wait in an office for an ungodly amount of time perusing through a magazine, and then proceed to wait in a cold examination room, with a big paper napkin tied around you.

There, you might step on a scale and get your blood pressure taken. Your doctor quickly checks your abdomen, throat, nose, ears and eyes, and listens to you breathe. She asks you a few questions while looking at a computer screen, perhaps orders some more labs, and then sends you on your way.

But does any of this actually help? Do annual exams help create a healthier population?

Actually, no, the evidence suggests. Let me clarify: Sure, some lab testing and infrequent preventive cancer-screening tests are helpful. But the standard annual physical for most healthy adults? No. In fact, I think they're pretty useless.

Annual Exams: Expensive, Not Evidence-Based, and Potentially Harmful

America spends more per capita on health care than any other country — more than twice the average developed country. In particular, we spend about $10 billion a year on annual physicals.

And yet, World Health Organization data shows that American ranks only 34th worldwide for life expectancy. We have one of the highest rates of infant mortality and obesity across the globe. And in a 2013 study comparing 17 developed nations, the U.S. ranked dead last for overall health.

Annual physicals aren't helping. In fact, there's no evidence that annual physicals reduce the onslaught of disease or death. In studies in which subjects were randomly assigned to get a physical or not, researchers found no difference in health between the two groups.

Not only are annual physicals likely useless — they might also be harmful. That's because randomly testing asymptomatic healthy adults can often lead to "false positive" results. And a false positive leads to increased stress and worry, along with potentially more invasive tests and procedures (like medication and surgery), which might be completely unnecessary. It's a monetary, logistical, and emotional waste.

It's part of the reason why the Society of General Internal Medicine advised against annual exams for patients without symptoms in 2013. The U.S. Preventive Services Task Force also doesn't specifically recommend them. And a number of prominent doctors have recently published editorials calling for doing away with the annual physical.

"Eliminating the annual physical might appear contradictory to our health care system's increased attention to prevention," two Harvard Medical School professors noted in a 2015 New England Journal of Medicine editorial. "But it is evidence-based prevention that's key, and the annual physical is not evidence-based: research has demonstrated both its minimal benefit and potential harms. We believe it's time to act on this evidence and stop wasting precious primary care time."

Considering all this — the lack of evidence indicating its effectiveness, the amount of time wasted, and the evidence of excessive false positives and the unnecessary testing, procedures, medicating, and anxiety that come with them — you have to wonder: Why are annual physicals still a thing?

Everyday lifestyle choices are the best preventive medicine out there.


What to Do Instead: Check in With Your Doctor Infrequently & Maintain a Healthy Lifestyle

With all this in mind, you might be wondering what you should do instead. First, it's important to note that elderly adults and children should still visit a doctor annually in most cases. And some specific preventive tests — like colonoscopies and cervical cancer screenings — are indeed evidence-based.

But as for a standard physical for healthy adults who aren't experiencing any symptoms? A routine check-in with your primary care doctor only every three to five years is probably fine.

I still believe that an infrequent visit with the doctor is a good way to create a relationship between doctor and patient. Considering the onslaught of diet-related disorders like diabetes and obesity in the United States, I’m not saying we should all be flying blindly. But starting a conversation with patients about how they are eating, sleeping, moving, and feeling might ensure a better bill of health than looking down their throats.

And in between visits with your doctor? The most important thing we can do every day? Maintain a healthy diet and lifestyle.

Doing what you can to maintain health through everyday lifestyle choices is the best preventive medicine out there. Remember, it can be as simple as doing these:

  • Eat a whole food, nutritious diet
  • Limit processed food and chemical substances in your mouth and on your skin
  • Limit sugar intake
  • Exercise
  • Drink lots of water
  • Get seven to eight hours of sleep every night
  • Don’t smoke
  • Don’t abuse drugs or alcohol
  • Reduce stress and increase joy
  • Surround yourself with love and people

For more on how to become healthier in 2016, check out my free, daily seven-minute challenge.

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