For decades, the annual physical and its attendant blood tests, or routine labs, have been mainstays of American medicine. However, in recent years, the message from some in medicine has effectively been: Don’t bother. In 2015, Ezekiel Emanuel, an oncologist and professor of medicine and bioethics at the University of Pennsylvania, pointedly told Americans: “Skip your annual physical.” Since 2013, the Society of General Internal Medicine has recommended against annual general health checks for patients who have no active symptoms or concerns. Disruptions from the Covid-19 pandemic have only further discouraged people from making regular doctor’s visits.
And yet every year, tens of millions of Americans still schedule and attend a checkup, with insurers usually covering the cost. Are they wasting their time?
Before we get to that, it’s important to draw a distinction between a physical and a checkup. A checkup can generally be described as a health care visit that includes multiple screenings and risk factor checks, in order to identify problems early and prevent future illness. Physical exams, on the other hand, are sometimes performed during a checkup visit and often include screenings involving the “laying of hands” on a patient. For example, a physical exam may involve measuring blood pressure with a cuff or monitor, feeling a patient’s abdomen for signs of swelling or cancer, and tapping their knee with a reflex hammer.
Beyond Pap smears and height, weight, and blood pressure measurements, no part of the physical exam has been clearly shown to increase disease detection, improve health, or decrease mortality. Similarly, no medical organization recommends getting routine labs, beyond a few screening tests for conditions like high cholesterol, hepatitis C, and HIV. For people with no symptoms, blood tests are much less likely to uncover unknown disease than they are to produce a false positive, which can in turn can cause anxiety, waste patients’ money and time, and lead to unnecessary, risky, and sometimes invasive follow-up testing.
But what of checkups? Along with colleagues at Northwestern University’s Feinberg School of Medicine, we recently conducted a review of 32 randomized trials and observational studies to gauge the value of checkups in adults. Our conclusion? Well, it’s complicated.
First, the bad news. There is no clear proof that regular checkups help adults live longer or prevent cardiovascular events like heart attacks or strokes. That’s largely because it’s difficult to disentangle the effects of regular checkups from outside factors in experimental studies. Many of the studies we reviewed, for instance, were conducted in Western European countries where health care systems are organized around universally affordable, accessible primary care. So even in the control groups consisting of people who skipped checkups, there were usually patients who received other forms of primary care. Also, most of the studies examined the impact of only one or two checkups; it is probably not realistic to expect that such a small number of doctor’s visits could lead to measurable reductions in mortality.
But there was some good news. Checkups were consistently associated with increased use of preventive services, like vaccinations and cancer screenings. Such preventive care has been shown to decrease risks of certain illnesses and improve survival rates for certain cancers. Checkups also sometimes lead to earlier detection and treatment of chronic conditions like high blood pressure, high cholesterol, and depression. Getting some chronic conditions under control, especially high blood pressure, can increase both the length and quality of patients’ lives.
Beyond Pap smears and height, weight, and blood pressure measurements, no part of the physical exam has been clearly shown to increase disease detection, improve health, or decrease mortality.
And more good news: Patients report feeling better after a checkup. In randomized trials, checkups led to increased quality of life, better self-rated health, less worry, and other positive outcomes. Beyond the fact that patients may be getting needed care, it’s not clear why checkups have this effect. However, it might be that patients feel better simply because they are taking charge of their health. Another potential factor has to do with a relatively unstudied aspect of checkups: the importance of meeting with and forming relationships with trusted health care professionals. Studies suggest that just talking to someone about health concerns can make patients feel better. It can be reassuring for people to know they have a place to go with health questions or if a problem arises. And if checkups help people feel better, they’re probably more likely to want to return in the future.
So, who stands to benefit most from a checkup? Our review found that a checkup visit probably has limited value for people who are up to date on recommended preventive care and for patients who regularly visit their primary care physician for other reasons, such as previously diagnosed chronic conditions.
But groups with many preventive care needs and those at highest risk may have the most to gain. For example, several preventive services are recommended for people age 50 to 59; for patients in that age group, a checkup visit can be a convenient opportunity to discuss, schedule, or even receive those services. Checkups are also clearly valuable for people who have overdue preventive screenings, who have not had a primary care visit in two or more years, or who describe their overall health as fair or poor. In recent European studies, checkups led to higher rates of diagnosis and treatment of chronic diseases in racial and ethnic minority patients, and in patients with low education levels. Checkups may also be an ideal setting for physicians to discuss Covid-19 vaccines (and booster shots) with vaccine-hesitant patients, who could then be vaccinated immediately afterward.
In all, the annual physical and routine labs are unnecessary and fine for most adults to skip. But a regular checkup might help you stay up to date on recommended preventive care, better manage chronic disease, and generally leave you feeling better. Perhaps most importantly, it can foster healthy primary care relationships for the present and the future. In other words, we should all have a checkup from time to time.
David T. Liss is a Research Associate Professor in the Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine. He is the first author of a recent review article on checkups, published in the June 8, 2021 issue of the Journal of the American Medical Association.
Jeffrey A. Linder is the Michael A. Gertz Professor of Medicine and Chief of the Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine. He is the senior author of the recent review article on checkups in JAMA.
“However, it might be that patients feel better simply because they are taking charge of their health. ” I’d suggest it’s the opposite, people feel better because they have turned over their health care to a “professional” and they feel like they can stop thinking about it for awhile. Which may be why it looks like there is no difference in health outcomes when people visit their doctor regularly, for every person who has a breast cancer caught there is probably a person who stops worrying about self-exams because the doctor told her she’s fine. In my experience, checkups can also be counterproductive because of the “to a man with a hammer, every problem is a nail” effect. When I was a young and fit woman, every visit to the doctor for any symptom led to suggestions to start using a chemical contraceptive and to get a flu vaccine. Could be anything from a headache to a stubbed toe, go on the Pill and get the flu shot. Now that I’m old and fat, every single doctor visit has to include the “eat 5 vegetables a day and exercise for 20 minutes” advice. If I broke my arm or came in with malaria, that would be at the top of the list. Regular checkups when there are no symptoms just become an abuse session, not good for the patient-doctor relationship.