It’s a common question that arises on both the national and individual level: is there a benefit to a yearly “complete physical”? Some doctors and patients swear by them and recount stories of miraculously early diagnoses that seem to soundly support the practice. But those are stories, and for every fan of the annual exam there is a detractor, who notes the waste of time and money involved in testing someone who feels fine. Fortunately, medicine is a scientific endeavor in the 21 Century, so careful statistical analysis can help put this controversy to rest.
First, let’s define “complete physical.” This term is generally reserved for a visit with a doctor, physician’s assistant, or nurse practitioner during which a broad range of health topics, complaints, and risk factors are discussed and a multisystem examination is performed on a basically asymptomatic person, all with the goal of determining whether a hidden health problem that would benefit from early intervention is present. So, even if your doctor has a lengthy conversation with you and does a thorough exam to, say, evaluate a complaint of fatigue, that is not considered a complete physical because the goal was focused on diagnosing the source of the symptom.The complete physical examination (CPE) is best viewed as a primary care provider’s tool to ensure all appropriate and proven preventive health strategies are being implemented for their patients.
The organization charged with assessing the efficacy of preventive health protocols is the esteemed independent think tank called the United States Preventive Services Task Force (USPSTF). It collects and analyzes the abundant data arising from monitoring medical practices and patient outcomes and uses the results to recommend (or condemn) certain health care strategies. Interestingly, excluding items pertaining to children or pregnant women, the USPSTF truly supports only 22 interventions. Most lay people are surprised to learn there are only three recommended/proven cancer screening tests. They are: the mammogram for breast cancer, PAP Smear for cervical cancer, and colorectal screening for colon cancer—and there are very specific limits advised regarding patient age and testing intervals. To some folks that seems insane, for cancer is such a significant killer, but the key is that for the vast majority of cancers there aren’t useful screening tests and/or they are not vanquished by early detection.
Of the remaining validated preventive care measures, eight are dedicated to assessing a patient’s “lifestyle” risk factors—smoking, alcohol use, level of sun exposure, level of exercise, sexual practices, mood issues, dietary habits, and obesity. The USPSTF urges physicians to evaluate their patients for these issues and regularly counsel them about the benefit of and strategies to improve their lifestyle habits. This has been shown to improve subsequent health outcomes! And for those with at risk behavior, checking for four specific venereal diseases —HIV, chlamydia, syphilis, and gonorrhea—statistically benefits the future well-being of those individuals.
So far, that covers 15 of the known helpful items that should be considered during a CPE. What’s left? Monitoring blood pressure and cholesterol, checking for diabetes in certain people, advising men between the ages of 45 and 79 to consider a daily aspirin, testing for aortic aneurysms in 65 year old men who have ever been smokers, screening for osteoporosis in 65 year old women, and instructing all women who might become pregnant to take a folic acid supplement in order to reduce the risk of birth defects.
Even if you see your physician regularly for specific health concerns, it is unlikely that he or she has been able to ascertain your status regarding these 22 known health-preserving strategies. So doctors usually view the annual complete physical exam as an almost sacred event that allows them to be certain you are doing everything that you are supposed to do! But is a CPE necessary? Well, if you are a slender, nonsmoking, physically-active, chaste or monogamous teetotaler with a healthy diet and you already gets regular blood pressure, cholesterol, and sugar measurements, take recommended supplements, and undergo mammograms, PAP smears, and colonoscopies at the recommended intervals, you probably don’t need one!