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Value of annual medical checkup questioned

The customary annual physical checkup at the doctor's office may not be worth the time or money, researchers said on Monday.
/ Source: Reuters

The customary annual physical checkup at the doctor's office may not be worth the time or money, researchers said on Monday.

About 63 million U.S. adults visit a doctor annually for a routine medical or gynecological checkup at a total cost of $7.8 billion, according to a study intended to help answer questions about the value of this trip to the doctor's office.

More than 80 percent of preventive care provided by doctors does not take place during this annual checkup, the study showed. And more than $350 million worth of potentially unnecessary medical tests are performed, the researchers said.

"We need to question encouraging everybody to come in for an annual physical," Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine and the RAND Corp., who led the study, said in a telephone interview.

"There's a lot of money, a lot of visits, a lot of adults going to see their doctor for annual physical exams with a real unclear benefit. It's the No. 1 reason adults see their doctor, and yet we don't know whether it's helpful or not," he added.

The study appears in the Archives of Internal Medicine.

These checkups account for one in 12 adult outpatient visits to the doctor's office, the study found. On average, they lasted 23 minutes and cost $116, including laboratory and radiology services, the researchers said.

More in Northeast get annual checks
The study also documented differences across the country in routine annual physicals. People in the Northeast are far more likely to get them than those in the West. The kinds of care and testing provided by doctors also varies by locality.

Many patients were routinely given laboratory tests such as complete blood cell counts or urinalyses of uncertain medical value in the absence of a specific reason, the study found.

Mehrotra said no major North American clinical organization advises people to get an annual medical checkup, but most adults think they should get one and most doctors recommend them.

"I'm not saying that preventive care itself is not helpful. It is clearly helpful — mammograms, pap smears, cholesterol screening, colon cancer screening, prostate cancer screening. And patients should get those. But does it need to happen at this special visit? Or can we get it some other way?" he said.

The institution of the annual medical checkup, intended to detect or prevent unseen health problems, dates back about a century in the United States, Mehrotra said.

No major medical benefits
But large studies in 1960s and 1970s failed to show these checkups provide a significant medical benefit to the patient, and there has been a debate about their value ever since.

The researchers examined government survey data from 2002 to 2004, and questioned doctors nationwide about what they did during the checkups.

Only 20 percent of eight preventive services tracked by the researchers were performed at these checkups as opposed to during other types of visits to doctors, the study showed.

Most patients visited the doctor for some other reason during a given year, it found.

But these checkups were the most likely time for some key preventive services like Pap smears and mammograms.

"Is a physical harmful at all? To the patient, there's likely little harm. The potential downsides of a physical are the money and people's time," as well eating up a doctor's time that might be better used elsewhere, Mehrotra said.