Is an annual physical necessary? The doctor is out on that one...
When was the last time you got a full physical, with the doctor checking you over from your ears to your knees, ordering a few blood and urine tests just to make sure everything was okay?
Not in the last year? Maybe not ever? Relax; if you’re feeling good, that may be just fine.
Many of us have grown up believing that a full checkup once a year was the best way to stay healthy. That even if we went to the doctor once in a while for a minor throat infection, we should still make an appointment for a physical once a year. Turns out annual physicals for healthy adults don’t make a lot of sense; in fact, they might even do more harm than good.
Many researchers have been saying for years it’s time to ditch the annual checkup. Way back in 1976, the federal government decided to look at whether annual physicals were worth the tax dollars that went into them. They created the Canadian Task Force on the Periodic Health Examination to do a checkup on "routine annual checkups."
Three years later, what this panel of experts concluded was that the “routine annual physical exam should be discarded.” Instead of full annual exams, doctors should create “selective plans of health protection packages” appropriate to the health needs of the different stages of life.
In other words, people of different ages need different tests, and many of these tests don’t need to be done every year. Older adults or those with certain health conditions may need to see their doctor often; healthier patients can often go longer between visits. There is no one-size-fits-all rule.
And yet, 30 years after that task force’s report, it’s clear Canadians still love their annual checkups. An Ipsos Reid poll in 2011 found that 45 per cent of Canadians regularly go to the doctor for complete top-to-bottom physicals.
More recent studies have also found that annual checkups aren’t helpful. One review conducted by The Cochrane Library found that people who get full physicals are more likely to undergo more health tests but aren’t any less likely to die from serious diseases such as cancer and heart disease, or from other conditions either.
Not only are annual check-ups in healthy people not very effective at spotting hidden disease, they lead to their own problems.
They tend to use up lots of health care dollars, for one; they force people to take time off work to attend them; they can lead to unnecessary testing, and they take time away from family doctors that could be better spent on patients with greater needs.
Yet many family doctors tend to have a soft spot for annual physicals too, with surveys showing that, despite the evidence against annual checkups, many GPs are reluctant to do away with full physicals.
One survey of almost 800 U.S. family physicians found the majority believed that annual checkups improved their ability to find hidden illnesses and were of proven value, despite evidence to the contrary. Most also believed that such examinations were expected by their patients.
In recent years, several provinces have begun taking action to discourage unnecessary annual exams. British Columbia’s Medical Services Plan no longer pays doctors for full checkups of patients who have no symptoms of illness.
And since 2013, family doctors in Ontario no longer conduct full head-to-toe physicals on adults, but instead offer “personalized health reviews” in which the doctor focuses on the health risks specific to the patient and the patient’s age.
These health reviews are meant to be more targeted and thus quicker, which is why the province now pays doctors less for them than for full old-style physicals. (Seniors and patients with chronic conditions can still have full physicals)
The College of Family Physicians of Canada doesn’t have a national policy on how often patients should receive checkups, so around the rest of the country, there’s a hodge-podge of policies.
Nova Scotia, New Brunswick, and Newfoundland and Labrador no longer cover annual physicals in patients without symptoms of illness. But they are covered in Alberta, Manitoba, Saskatchewan, Quebec, Prince Edward Island, and the Northwest Territories.
While many adults don’t need to see a doctor every year if they’re feeling well, that doesn’t mean they can go for years without visiting one. Even healthy adults are advised to have their blood pressure checked every year, for example. Adults and teens who are sexually active may need testing for sexually transmitted illnesses. And once adults reach 40, 50 and 65, there are several screening tests they should begin doing.
Every patient is different so patients need to discuss with their doctors about how often they should be coming in for check-ups.
Here’s a guide to some of the screening tests that all Canadians are recommended to undergone and how often they should be done.
CHOLESTEROL: The need for cholesterol testing depends on a person’s family history and risk factors for heart disease, says the College of Family Physicians of Canada. With no risk factors, routine cholesterol screening usually begins at age 40 for men and 50 for women or earlier if they have stopped having regular menses.
The Heart and Stroke Foundation recommends all adults have their blood pressure checked at least once a year, although the test can be performed at a pharmacy. Those diagnosed with high blood pressure may need to have it checked more often.
MAMMOGRAMS: Women aged 50 to 69 should have a mammogram every two years, the Canadian Cancer Society recommends. Those under 50 should talk to their doctor to determine if they are at higher risk of breast cancer and whether they need mammography earlier.
DIABETES: Men and women over the age 40 should be screened for diabetes using a fasting blood glucose test every three years. Those with several risk factors for diabetes may need earlier testing or more frequent testing.
CERVICAL CANCER: The Society of Obstetricians and Gynaecologists of Canada recommends that women over 21 have a Pap test once a year until they have had two normal test results in a row. Then they will need one only every three years until age 70.
COLON CANCER: Adults over 50 should do a colorectal screening test every two years. If they have a family history of colon cancer, their doctor can discuss the need for a colonoscopy.
OSTEOPOROSIS: All women and men over the age of 65 years should get a bone mineral density or BMD test, though some adults under 65 may need the test earlier if they are high risk.
KIDS: Babies need to see a doctor five times in their first year of life, at 2, 4, 6, 9, 12 months and then again at 18 months and 2 years. After that, they should see their doctor once every year until age 5, to monitor their growth and development. When the child is 5 years old, s/he should see a doctor every 1 or 2 years until she is 18.