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Study Questions the Value of Annual Physical Exams

By Brenda Goodman, MA
WebMD Health News

Reviewed by Louise Chang, MD

Oct. 16, 2012 -- Regular physical exams are annual rituals for many Americans.

Now a new research review finds that these kinds of checkups don't help people live longer, and they don't cut the risk of dying of cancer or heart disease.

"We did not find any signs of benefit," on death risk, says researcher Lasse T. Krogsboll, a PhD student at the Nordic Cochrane Center in Copenhagen, Denmark.

Despite the dim light the review casts on annual exams, researchers and independent experts say it's not necessarily time to give up on regular physicals. For the study, researchers pooled data from 14 studies that included more than 180,000 people. All the studies randomly assigned people to one of two groups: The first group was asked to get regular checkups; the second group only saw a doctor as needed.

Tests done during the checkups varied from study to study, but most included measures of blood pressure, cholesterol, blood sugar, heart rhythms, vision, and hearing.

Studies included in the review followed people for as little as four years and as long as 22 years.

Benefits and Harms of Annual Physicals

When researchers compared the number of deaths between the group that got regular physical exams and the group that only saw a doctor as needed, there was essentially no difference.

On average, about 7% of people died in each group over the course of the studies. That was true even when researchers looked at deaths from cancer and cardiovascular disease, which are thought to benefit from early detection and treatment.

Perhaps unsurprisingly, people who saw a doctor on a regular basis were more likely to be diagnosed with conditions like high blood pressure and high cholesterol.

Some studies found they were more likely to be treated for those conditions, too. Out of four studies in the review that looked at drug use, two found that people who got regular physicals were more likely to be prescribed drugs to treat high blood pressure, for example.

There was a trend among studies for people who got regular physicals to feel healthier than people who did not, but researchers say that finding is unreliable. There were no apparent differences between groups on hospital admissions, worry, referrals to specialists, or disability.

"In the absence of documented health benefits, we would say there's a risk of overdiagnosis from this," Krogsboll says.

Should We Leave Wellness Alone?

"One of the questions that arises from this study is, 'Why didn't an annual physical work?'" says Michael LeFevre, MD, MSPH, co-vice chair of the U.S. Preventive Services Task Force, a group of government advisors that weighs the evidence behind different kinds of preventive services and makes recommendations about their use.

One reason may be that most of the studies included in the review were done in the 1960s and '70s, an era when doctors ordered many tests during wellness exams.

Some of those tests, like electrocardiograms (ECGs or EKGs), have since been shown to have little value for general screening.

In contrast, only some of the studies asked people about smoking. In one study, people were only offered help to cut back if they were smoking more than 15 cigarettes a day.

Quitting smoking, LeFevre points out, has enormous benefits for health.

"It emphasizes the importance of doing what works. Just showing up for a check-up isn't going to make you live any longer," he says.

Another reason there may have been no difference between the two groups, researchers say, is that people who were going to the doctor might have been getting good preventive care on the side during those visits.

"So adding systematic health checks did not add any health benefit," Krogsboll says.

But other experts found the findings solid and even similar to the results of other reviews showing limited benefits for annual physicals.

"This study adds to growing evidence about the limited role of the periodic health examination in healthy adults," says Timothy J. Wilt, MD, MPH, a professor at the University of Minnesota's School of Medicine in Minneapolis.

Wilt just finished another review of annual physicals for the Department of Veterans Affairs. His conclusion? They don't do much for healthy adults.

Despite that, he says many people just like to get regular physicals and feel reassured by checking it off their list.

In those cases, he says, "We and others recommend that patients and providers should focus on areas of demonstrated health benefits and address concerns if patients notice any abnormal signs or symptoms."

SOURCES: Krogsboll LT, The Cochrane Library, 2012 Issue 10. Lasse T. Krogsboll, PhD student, The Nordic Cochrane Center, Copenhagen, Denmark. Michael LeFevre, MD, MSPH, professor, Future of Family Medicine, University of Missouri School of Medicine, Columbia, Mo.; co-vice chair, U.S. Preventive Services Task Force, Rockville, Md.Timothy J. Wilt, MD, MPH, core investigator, Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center; professor, University of Minnesota's School of Medicine, Minneapolis, Minn.

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