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Question: Over a year ago I got a new family doctor. I have been saving up my questions for my first annual check-up with him. But when I arrived at his office, he said he doesn’t do annual check-ups and he will deal with only one or two of my questions at each appointment. I’m suspicious. Does my doctor want me to come more often so he can make extra money?
Answer: I can’t comment on your doctor’s financial motives. After all, who really knows what another person is thinking? But I can say with some certainty the annual physical exam is falling out of favour with a significant part of the medical community.
“The evidence doesn’t actually show that going in once a year for the average person leads to better health outcomes,” says Dr. Joshua Tepper, CEO of Health Quality Ontario, a provincial agency with a mandate to improve the health-care system.
“So, it’s not considered a best practice to do annual exams,” he adds.
Indeed, numerous studies have found that people who have a yearly check-up don’t tend to be healthier or live any longer than those who forego the visits. Doctors are unlikely to find something that needs immediate attention in these generalized reviews of healthy adults who are free of obvious symptoms.
Based on the overwhelming strength of this research, some provinces – such as New Brunswick, Nova Scotia, Newfoundland and Labrador – have stopped paying doctors to perform yearly physicals.
A few others have “modernized” the visit, so it no longer resembles the traditional annual check-up, in which a patient is examined from head to toe and gets a standard set of lab tests.
In Ontario, for instance, the annual check-up was revamped in 2012 when the government negotiated a new contract with the province’s doctors. It’s now called the Periodic Health Visit. As the name implies, it’s done periodically and not necessarily every 12 months. Rather than everyone getting the same batch of tests, doctors are supposed to focus on the specific needs of individual patients – taking into account their age, sex and medical history.
The amount Ontario physicians are paid for the visit was also reduced to $50 from $72, partly because the Periodic Health Visit takes less time than the old-fashioned check-up.
Cutting back on annual exams helps to trim costs, and these savings can be put to better use elsewhere in the health-care system. In the fiscal year 2011-2012, the costs for annual exams and related lab tests totaled more than $200-million in Ontario alone.
Aside from curbing expenditures, it really isn’t good for healthy patients to get tests they don’t need. Such tests can sometimes produce false-positive results – which are essentially false alarms. The tests may suggest you have a problem when nothing is actually wrong. But just to be on the safe side, your doctor will usually order follow-up tests and treatments that could create unnecessary anxiety or possibly even result in harm. An invasive test that shows the arteries in the heart can trigger a heart attack in some patients.
Doing away with annual physicals doesn’t mean you should avoid your doctor’s office for long stretches of time.
“People should feel comfortable seeking care when they are worried or have a problem – not just once a year,” says Dr. Tepper.
What’s more, you don’t need to wait until you have a long list of concerns before you book an appointment, says Dr. Lisa Del Giudice, a physician in the Academic Family Health Team at Sunnybrook Health Sciences Centre.
A typical visit with a family doctor is usually allotted about 15 minutes. If a patient arrives with numerous questions, there may not be enough time to adequately address them all “and something could get missed,” says Dr. Giudice. “In order to properly assess a health concern, physicians need more than a couple of minutes to take a detailed history and perform a physical exam.”
So, how many questions should you bring to an appointment? Dr. Tepper says it’s okay to raise all your concerns. But don’t be surprised if your doctor asks you to come back at a later date to deal with some of them.
If you have a problem that is serious, then it is better to have it addressed sooner rather than later, says Dr. Tepper. And if the doctor concludes it’s not an urgent matter, then at least your mind will be at ease.
Overall, the timing of your doctor visits should be linked to your actual health needs – rather than an arbitrarily date set for an annual check-up.
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Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.