The value of an annual physical exam has been controversial since I started my practice in 1982. Over and over again research has failed to demonstrate that people having annual or preventive exams experienced better health and longevity than those who did not have routine exams. Why is is so difficult to prove something that intuitively feels obvious? The answer is that research outcomes depend on what is measured.
Traditionally, the annual exam was a time for patients to pause and review their health, and to have a conversation with their Health Care Provider. It was important to develop a relationship with the person, who may have to help you with sudden, difficult health care decisions. Unfortunately, the new fragmented health care model has undermined the value of this Patient-Provider relationship. Many Primary Care Providers do not follow their patients to the hospital where the majority of these difficult decisions occur.
On a routine physical exam when the person has no specific complaints, research has found no value with auscultation of (listening to) the lungs to find lung cancer. However, which approach is more likely to help a person stop smoking: 1) reading a pamphlet, 2) going to a smokers anonymous group meeting, or 3) having your health care provider encourage you to stop after listening to your lungs? You understand the difficulty of studying the many variations of the art of medicine.
The new system thrives on consistency, which favors a fragmented approach of check-off boxes to make sure all items are current and up-to-date. Primary Care Providers, slowly starved of resources and shielded from competition, have been criticized for having large numbers of patients with out-of-date preventive health care services. This degenerated to an inefficient program of reminders coming from multiple sources. It is not unusual to get a reminder for your mammogram from your insurance company, radiology group, breast surgeon and primary care provider. And if you change insurance companies (as we are encouraged to do to reduce costs), no reminder. How many providers have changed their practice or moved out of town? No reminder. You can see the problem.
We are moving into a new health care system that emphasizes “population health”. As individuals we are doing a poor job of maintaining our health, so I envision a new category or layer of health care providers, called health care coaches, to help patients navigate their lives and health care. They will double check your list and help you sort though the remaining boxes. Cost is not an issue: it will improve our unemployment numbers and health insurance is mandatory.
I am getting a little sarcastic. I try to remain positive and optimistic, and just realize it is out of my hands. I still believe we are responsible for our own health.
In the first segment we will check off (I meant start off) with the controversial topic of vaccination.
Mark Pierce, MD.
This editorial represents my personal views and not the views of HTMC or other providers, etc.
Next: Vaccines – Effective or Dangerous
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