Some headlines say ‘skip your annual physical,’ but routine check-ups have many benefits.
Some leaders in health care have called for an end to annual health check visits, saying they’re a waste of time for patients and overworked primary care physicians and don’t reduce the risk of death.
A new Northwestern Medicine study found while there is no clear proof that regular check-ups help adults live longer or prevent cardiovascular events like heart attacks or strokes, they still have many health benefits — especially for at-risk populations — and should continue.
Routine check-up visits (they don’t have to necessarily be done annually) can lead to better detection and treatment of chronic illnesses such as depression and hypertension, an increase in vaccinations and screenings for diseases like cancer, and improve how a patient actually feels after visiting with a doctor (patient-reported outcomes), the study found.
“While it is disappointing that I can’t tell my patients a visit with me or my colleagues will help them live longer, it is good to know there are proven, measurable benefits,” said senior study author Dr. Jeffrey Linder, chief of the division of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
The study is a review of 32 studies conducted between 1963 and 2021. It will be published today (June 8, 2021) in the Journal of the American Medical Association.
“I was surprised at how many benefits we found when we dug into the data, given the negative messaging around these exams,” said first study author David Liss, research associate professor of medicine (general internal medicine and geriatrics) at Northwestern University Feinberg School of Medicine. “Especially when it relates to patient-reported outcomes. If you walk away feeling healthy, it becomes a self-fulfilling prophecy.
“I think a lot of the critics meant to say ‘Don’t do these annual exams for low-risk patients,’ but the message came out to not do these exams at all, which is problematic.”
‘Sick visits’ don’t allow for all the necessary screenings
For at-risk populations, these exams are still vital, Liss said. They include patients who are ethnic/racial minorities; overdue for preventive services and have uncontrolled risk factors, such as diet, exercise and smoking; low self-rated health; don’t have a single source of trusted care; or live in geographic areas with low access to primary care providers.
“A lot of people only see a doctor when there is a problem,” Liss said. “But that often doesn’t leave time to talk about vaccinations or cancer screenings. It’s easy to see the value in routine checkups because there are multiple recommended services that could be discussed in these visits.”
Cost should not be a factor because every patient with Medicare coverage and many insured patients under age 65 can get an annual wellness visit for $0 copay, Liss said.
The study examined a variety of factors, including mortality (risk of premature death) and cardiovascular outcomes (heart attacks or heart disease), which did not benefit from general health checks.
However, several remaining factors saw added benefits from routine check-ups, including chronic disease detection (e.g. increases in statin or depression prescriptions); risk factor control (improved blood pressure, cholesterol readings); clinical preventive services (more screenings and vaccinations); and patient-reported outcomes.
‘The patient is the only person who knows how they feel’
Physicians are increasingly talking about “patient-reported outcomes” or “self-reported outcomes” as a measure of someone’s health, almost equivalent to lab results or scan readings.
“It speaks to peoples’ states of mind,” Liss said. “There’s a general sense of health when they walk away from these visits, maybe thinking, ‘Hey, I’m not as unhealthy as I thought I was.’ The patient is the only person who knows how they actually feel. The feelings people carry with them are important to their health and wellbeing over time.”
Seeing a consistent and trusted source of primary care is important to foster relationships and makes it easier to reach out to doctors when there is a problem, Liss said, adding that just talking to someone about your concerns can make you feel better.
Reference: “General Health Checks in Adult Primary Care: A Review” by David T. Liss, PhD; Toshiko Uchida, MD; Cheryl L. Wilkes, MD; Ankitha Radakrishnan, BA and Jeffrey A. Linder, MD, MPH, 8 June 2021, JAMA.
Other Northwestern co-authors include Toshiko Uchida, Cheryl Wilkes and Ankitha Radakrishnan.