Serial inveigher Dr. Ezekiel Emanuel — I’ll explain in a moment — has set off yet another hoo-ha with his provocative suggestion that Americans ditch their annual physical exams. Forty-five million of us get an annual physical, he writes in a New York Times op-ed, but we shouldn’t bother: “The annual physical exam is basically worthless.”
Emanuel, an oncologist at the University of Pennsylvania, says that a study of annual physical exams from 1963 to 1999 reveals that the tests “did not reduce mortality overall or for specific causes of death from cancer or heart disease.” What’s more, “the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.”
Emanuel, one of a troublesome trio of brothers (Rahm runs Chicago; Ari Emmanuel is a famously disputatious and successful Hollywood agent), loves to stir the pot. He recently wrote a lengthy provocation for the Atlantic magazine, titled, “Why I Hope to Die at 75.” He doesn’t really want to die at 75, but never mind that.
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We all have an interest in this subject, and I will declare mine: I love my annual physical. Of course, I never bothered with this until about age 30, but now I enjoy it. I regard it as my yearly new lease on life, as long as the lease can be renewed, I guess.
It’s true that my primary care physicians haven’t bothered to show up to my physical in the past few years; they’ve become “concierge doctors” and I’m no longer their patient. But a perfectly competent physician’s assistant palpates me and so on. The ever-rotating cast of phlebotomist-vampires smile politely as my blood swirls into their vials. What fun!
It’s an annual encounter from which I retain literally every word. The docs used to ask me leading questions about my mood (always negative, I assured them) and my sexf life (no further comment). I figured they wanted me to reach into the Magic Formulary which Cures All Ills — e.g., Lunesta, Viagra — but I wasn’t interested. I tried to direct the conversation to my grape-sized sebaceous cyst, but it has failed to capture their interest lo these many years.
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When I whined about what is now called overweight, I remember my doctor saying: “Eat less fat.” When I started experiencing hip pain a few years ago, my then-doctor mumbled, “Well, we want to keep you out of the hands of the surgeons.” Pretty funny line, albeit easier said than done.
The American Medical Association agrees with Emanuel. It e-mailed me a statement of Talmudic complexity, which said, in part: 1) “The periodic evaluation of healthy individuals is important for the early detection of disease,” but 2), “The optimal frequency of the periodic evaluation and the procedures to be performed vary with the patient’s age, socioeconomic status, heredity, and other individual factors.”
In English: Yes to periodic health checks, but they don’t have to be annual. Dr. Claudio Burstein, assistant area medical director of Kaiser Permanente, California’s massive, and generally well-regarded insurance and health care provider, agreed. “Our policy isn’t about eliminating a service,” he said, “it’s about finding a better one. We honor any patient’s request for a physical exam,” but Kaiser turns every visit into what they call a “proactive office encounter,” with the aim of teaching patients to monitor many of their own vital data.
“We’d like to see a cultural change in this relationship,” he added, “but it can’t be done overnight.”
Should you skip your annual physical? Let your conscience be your guide. I’ve already made my appointment for next year.
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Related:
• Jeff Jacoby: No health care after 75? Time to reconsider
• Letter: Time marches on, and so do we — that’s a good thing
• 2013 | Alex Beam: The concierge doctor is in
• 2013 | Scot Lehigh: Best health care system? Not in the US
Alex Beam’s column appears regularly in the Globe. He can be reached at alexbeam@hotmail.com.