Annual check-ups aren't needed, US study says

BMJ 2007; 335 doi: (Published 27 September 2007) Cite this as: BMJ 2007;335:631
  1. Janice Hopkins Tanne
  1. New York

    Annual physical examinations, a staple of medical care in the United States for decades, cost too much and are not necessary for conveying messages on preventing illness, says a new study.

    Patients get most messages on prevention through other visits, explains the study, published in the Archives of Internal Medicine (2007;167:1876-83). But annual gynaecological exams may be helpful for women, it says.

    Ateev Mehrotra and colleagues from the University of Pittsburgh Medical Center examined data from 2002, 2003, and 2004 from the US national ambulatory medical care survey and the national hospital ambulatory medical care survey, which record visits made by patients with health insurance to office based physicians and to hospital outpatient departments for annual check-ups and gynaecological examinations.

    Dr Mehrotra, the lead author and an assistant professor at the University of Pittsburgh Centre for Research on Health Care, said that no major North American clinical organisation recommends check-ups and no medical organisation specifies what should be included in one. “Physicians need to reach a consensus on whether patients should have annual physicals and what the exam should consist of,” he said.

    During 2002-4 about 44 million US adults had an annual preventive physical check-up and about 19 million women had a preventive gynaecological examination each year. The authors say that that's about 21% of US men and 18% of women, for a cost estimated at $5.2bn (£2.6bn; €3.7bn) for general check-ups and $2.6bn for gynaecological examinations. The total amount nearly equals all spending on care of breast cancer patients in 2004, they report.

    Check-up visits accounted for one in 12 adult care visits. Almost every check-up included a blood pressure measurement. People in the north east of the US were 60% more likely than those in the west to have a physical check-up.

    Most preventive examinations were done by general and family practitioners, general internists, and gynaecologists. Preventive physical check-ups lasted an average of 23 minutes, preventive gynaecological visits averaged 20.5 minutes, and visits for other reason averaged 18 minutes. The average cost was $116 for a physical check-up and $136 for a gynaecological examination, including tests.

    Many tests are unnecessary and in total cost more than $350m a year, the authors say. A complete blood count, serum electrolytes test, urinalysis, and an electrocardiogram are often ordered as part of an annual check-up but are not necessary unless there is a reason to request them, Dr Mehrotra said. However, during gynaecological examinations women were likely to receive or be sent for evidence based tests such as mammography or cervical smear tests.

    The study looked at whether patients had received preventive or counselling messages about mammography, prostate specific antigen testing, cervical smear testing, cholesterol testing, stopping smoking, weight loss, and exercise and nutrition. Although advice on prevention is sometimes given as a reason for annual check-ups, the researchers found that almost 80% of preventive messages were given when a patient visited for another problem during the same year.

    Making annual examinations available to all US residents is unrealistic, the authors say. Instead US doctors should offer advice on prevention when they see patients for other reasons.

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