There has long been a belief that preventive medical services save money. The theory holds that if Americans’ primary care physicians ordered more preventive medical screening services we would not only be healthier but the cost of the preventive care would be more than offset by the savings from more serious care avoided. In other words, the cost of a colonoscopy would be offset by not getting colon cancer. It’s a nice theory and it is parroted by everyone from doctors, to media reporters, to politicians and sometimes even public health officials. It was even the (secret sauce) for my health plan at my first job in a hospital. The only problem with the theory is that it is wrong.
Extensive research from decades of careful studies have found that preventive medical services mostly come at a positive cost per life year saved. That is, they cost more to perform than they save in future medical costs avoided. Some are a bargain, however, saving years of life at insignificant amounts. The NCPA published a study by Tammy Tengs 30 years ago that outlined the cost of many life-saving interventions. A peer reviewed version of the research is available here. Changing your car’s oil at least once a every year is literally money saving as your engine would fail prematurely and require an expensive engine rebuild. There are almost no medical examples that when broadly applied save money similar to periodic oil changes for your car. One of the few preventive services that are literally money saving are childhood vaccinations but there are few others.
That they are not money-saving is not to say that preventive medical services are of no value. All I’m saying is they do not save money. Many things we pay for in life cost money but are still worth buying. That raises a question: is the annual physical exam of any value? Experts have finally began to wonder how much, if anything, is an annual physical exam is really worth?
A growing number of physicians say the value of a yearly physical depends in part on your age and health history, and that some young, healthy patients can afford to skip it. Some studies have suggested that the annual visits aren’t doing much to improve our long-term health, and a growing shortage of primary-care doctors can drag out appointment wait times.
Plenty of doctors still recommend an annual checkup, but more are changing what they do in that appointment, focusing on habits such as sleep, exercise and diet with less poking and prodding in a physical exam.
A lot of what your doctor does during an annual physical exam is superficial. It involves recording metrics that your doctor may have little control over, such as recording weight, asking about smoking or alcohol consumption and advising women on birth control. I get a complete blood count and other lab tests every year whether I see my doctor or not. The services costs around $170 a year and are of no therapeutic value. Yet, if there is something that my blood tests find I can take the results to my doctor. I have done this on several occasions. Otherwise, I archive my results until I see my doctor. My annual ritual of getting a CBC is probably more than my doctor would do during an annual exam.
Other than managing blood pressure, assessing body-mass index, and screening for cervical cancer in women, regular physical exams in asymptomatic patients haven’t been shown to improve health, says the latest recommendation from the Society of General Internal Medicine, a professional group.
A review in the medical journal JAMA found that overall, checkups weren’t linked to lower mortality rates or improvements in cardiovascular problems, although they were linked to better catching and treating of chronic disease.
The key is asymptomatic versus symptomatic patients. If you have symptoms, see your doctor. If you are young and healthy, going to see your doctor is of little benefit. Surveys have found that about 8-in-10 adults see their doctor once a year. That figure falls to about two-thirds for adults under age 45.
Public health officials are beginning to realize that physicians wasting less time performing physical exams (of no value on well patients) could free up more appointment slots for those who need them. That reminds me of an article I read earlier about a concierge medicine tech start up that will use artificial intelligence to manage patient care. Patients can access small kiosks at various locations anytime they want. If AI finds something, an actual flesh and blood doctor will evaluate the results and order care. Otherwise, the AI interface just records results against a baseline. A system that monitors patients and only requires the time of doctors when something comes up is a better solution than an annual snapshot in time. If you think about it, too many doctor visits are a hurried 10-or-15-minute encounters where little information exchanged beyond the immediate health complaint.
As Dr. Yul Ejnes, a primary-care doctor who sits on the board of the American Board of Internal Medicine, told the Wall Street Journal:
“There are parts of what we do in a yearly exam that are valuable.”
“It’s just that the delivery method that’s been used for decades may not be as effective as we think it is.”
It’s also not as efficient or as convenient as it could be.