I hate going to the doctor’s office. The truth is that I just don’t like getting shots (odd, because I don’t mind giving blood) and almost every year through grammar school and high school the annual visit included a shot for a vaccine or the flu shot. Before coming to Happy Valley, I had to go to the office so I could receive the Meningococcal vaccine, the one required if you live on campus. Just the name of that vaccine makes me shiver. Needless to say, I wasn’t thrilled when I had to go back for a flu shot, during the Thanksgiving break. When we were leaving the nurse at the counter asked about making an annual checkup appointment. Really, still? I started thinking about why we get an annual physical. Sure, if you are a child who needs vaccines or play on an organized sports team and need clearance to play, you should go to the doctor annually. Annual visits to the doctor may be warranted for people over fifty as well. But if you are a heathy adult, it seems unnecessary.
Null Hypothesis: Annual physicals are a necessary preventative measure for healthy adults.
Alternative Hypothesis: There is no need for an annual physical if you are a healthy adult.
Annual physical exams were endorsed by the American Medical Association in 1922 and have become part of a routine, for many, as a preventative measure and, for some, a reassurance that they are healthy. Routine physical exams normally include; a Q&A about general health, allergies, surgery and habits such as alcohol intake, tobacco use and frequency of exercise. They may also include urine tests and blood work and usually provide for temperature, blood pressure, pulse and examinations of your throat and ears.
In an article by U.S. News Health Care, the question of the need for a yearly exam is examined and concludes that annual visits to the doctor are not necessary. It suggests that if you are a healthy adult, visiting a doctor every 5 years would be reasonable. To support this conclusion, a study, by the Cochrane Collaboration, was referenced. This study analyzed results from 14 trials which included approximately 183,000 participants. The analysis showed that there was no effect on risk of death associated with cancer, cardiovascular disease or illness. One trial did detect an increase in cholesterol and high blood pressure, however, the analysis concluded that these patients may have already been suspected of high risk in these areas. Lastly, the trials were determined to have not influenced increased visits to doctors, work absences, disability claims or hospital admissions although, the data was vague and could be subject to the File Drawer Problem, Andrew discussed in class.
This Harvard Health Publication blog supports the elimination of routine annual visits stating that the visits do not stop you from getting sick nor prevent death. It states that, statistically speaking, tests ordered on healthy people produce false positive results identifying problems that don’t exist. It concludes that the emotional, financial and resource costs to conduct these tests are enormous and should be redirected to those truly in need. It suggests that online surveys and rigorous preventative steps by individuals can replace annual visits. This report references an article posted in the The New England Journal of Medicine which also provides convincing arguments to change the annual routine and consider visits based on evidence rather than the calendar. It agrees that false positive testing can do more harm than good and wastes a lot of everybody’s time.
Alternatives to annual physicals
WebMD documents when to get screened for the detection of particular ailments. It suggests, for instance, a cholesterol test every 4-6 years and a colonoscopy starting at 50 years old. Mammograms for women at 40 years old are recommended and blood sugar tests for those overweight should be considered. Of course, if you are predisposed to certain ailments or have a family history of disease, screening is warranted.
The research presented disproves the null hypothesis and accepts the alternate hypothesis that annual physicals are not necessary for healthy adults. During high school, I sponsored several blood drives. Since arriving at college, I have donated blood. When you donate blood, you are screened for a variety of things such as; weight, iron level, blood pressure, temperature, and pulse and you are asked to complete a lengthy questionnaire about your current health, travel, surgeries and habits. Sounds a lot like a routine physical to me and it is free! So, if you don’t have time to get to the doctor’s office, you can’t afford it or you just want to be a good person, donate blood and get a mini check-up for free!
Picture sources: http://www.usnews.com/dims4/USNEWS/ea8044b/2147483647/thumbnail/970×647/quality/85/?url=%2Fcmsmedia%2F74%2Ff0%2F5157150e4b7d8e55bbb0cb911c4f%2F140529-doctorexam-stock.jpg
U.S. News Health Care:
Study: Cochrane Collaboration:
Harvard Health Publications, Harvard Medical School:
The New England Journal of Medicine: Improving Value in Health Care – Against the Annual Physical:
Webmd Screening timelines:
Screened (blood donation):