Annual physical exam is probably unnecessary if you’re generally healthy

My husband hasn’t seen a doctor in at least five years. His last visit came when I insisted on taking him to the emergency room for help extracting a shard of wood he’d accidentally stepped on. Dave, a former athlete in his early 40s, is a fit, healthy nonsmoker. He’s never had an annual physical, and he doesn’t see any need to start now.

Once upon a time, an annual physical was just something you did if you cared about your health (and had the insurance to pay for the exam). But a recent review by researchers at the Nordic Cochrane Centre in Copenhagen suggests that my husband’s “wait for a reason” approach may be perfectly wise.

Researchers examined the most rigorous studies they could find (14 in all) comparing people who received so-called general health checks and those who didn’t, some 182,000 people in all. Their analysis found that routine medical exams failed to reduce overall deaths, disease-related deaths, hospitalizations or costs.

The Cochrane review isn’t the first to question the effectiveness of the annual exam. A 1979 Canadian panel convened by the government concluded that “the routine annual physical examination should be discarded in favour of a selective plan of health protection packages appropriate to the various health needs at the different stages of human life.” The U.S. Preventive Services Task Force does not advise for or against annual exams; instead, it makes age-specific recommendations about which screening tests you need and when, says Michael L. LeFevre, a physician at the University of Missouri and co-vice chair of this independent group of national experts.

Even without formal recommendations, many Americans continue to see their doctor once a year, whether they have symptoms or not. The 2009 National Ambulatory Medical Care Survey showed that general medical exams were the No. 1 reason people visited their doctors.

The annual physical became popular, in part, because it seems so logical that a regular exam might catch medical problems before they get out of hand, says Ateev Mehrotra, a health policy researcher and physician at the University of Pittsburgh School of Medicine. But given the lack of evidence that the yearly ritual improves health, he says, “my own view is that the medical community should no longer encourage patients to receive an annual physical.”

It’s not just that these exams are unlikely to help the patient, Mehrotra says. They come with potentially serious downsides, too.

For patients, the negatives include time away from work and possibly unnecessary tests. “Getting a simple urinalysis could lead to a false positive, which could trigger a cascade of even more tests, only to discover in the end that you had nothing wrong with you,” Mehrotra says.

There’s also potential for false assurance that everything is okay, which may lead people to ignore or minimize new symptoms. “You may come in and have a completely fine bill of health, and three months later you develop leukemia,” says physician Christine Laine, editor of Annals of Internal Medicine. “Unfortunately, we can’t prevent that from happening.”