My Wife Made Me Go to the Doctor

My wife forced me to make an appointment for a physical exam.

After avoiding it every way possible, I went. I had to find a new doctor because “my” doctor retired a couple of years ago. I suspect you are surprised I am resistant to go for an annual exam and to get blood work done.

Ninety percent of Americans believe that an annual physical exam is a useful and effective use of time and money. Medicare and most insurance providers pay for it, and we spend 12 percent of our healthcare dollars on physical exams.

My reluctance is based on my 30 years of experience in doing physical exams and the scientific evidence that clearly states physical exams do not improve health outcomes. Multiple studies culminating in a Cochrane Review (a scientific organization based in Copenhagen and the definitive word in these matters) concluded that annual physical exams failed to decrease deaths, hospitalizations or costs. The US Prevention Services task force does not recommend them and, in my own experience, I have found them extremely unhelpful in caring for people. This is especially true for young adults who feel healthy.

The annual physical exam came into vogue in the 1940s. Prior to that, you only went to the doctor if you were sick. But with new diagnostic tests and a refined understanding of disease, it made sense that early detection was a good thing.

Soon, medical schools taught the ritual of the physician with a stethoscope examining a patient from head to toe and patients came to expect it.

The problem is that a physical exam rarely, and in my experience almost never, unearths a problem in a way that leads to an improved outcome. That is, finding cancer that can be instantly cured or treating any disease early so that it doesn’t ravage the person’s body. More likely, a test will be positive and lead to further expense and uncomfortable procedures that produce anxiety, only to have them relieve the anxiety by ultimately telling the patient, “Everything is all right.” This happens a lot.

The only benefits that have been shown to result from annual exams is the detection of high blood pressure and cervical cancer through pap smear. But even pap smears are now only recommended every three years for women over 21 and every five years for women over 30 if combined with a check for HPV. Pap smears are to be discontinued in women over 65.

So, why have I agreed to go to the doctor?

1. I want to have a physician who knows my medical history before I have a significant medical problem.

2. I am at an age where I do need selected tests done that have been shown to be effective at improving outcomes (you can see these recommendations at http://www.healthfinder.gov).

3. I chose a physician whom I know believes as much as I do in true prevention. When I see her, I expect to devote as much time to a discussion of my diet, my exercise and my spiritual health as she spends poking and prodding my body.

To summarize, it is important to have a doctor who knows you and your health history. There are periodic health screenings that do need to be done that can help you remain healthy, but an annual physical exam and blood tests no longer makes sense for many people (unless your wife insists that you go).

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