Annual Checkups – Should You Have Them?

Majid Ali, M.D.

I have never not had an annual checkup myself. All my physical examination were done for insurance purposes only. I found these exams to be exercises in futility. Medical checkups fort specific reasons, of course, are crucially important.

In a companion article, I explain why I do not perform routine pelvic examination for my female patients. My position on annual checkups have been looked with deep suspicions by most doctors. That has not been my problem.

Annual checkups by American doctors (with disturbingly few exceptions) do not include any tests for the following (which I consider to be crucial):

1. Insulin toxicity

2. Toxic metal load

3. Environmental toxicities

4. Mold and food allergy

5. Assessment of nutrient assessment.

With background, I was pleasantly surprised to find an article titled “Skip Your Annual Physical” in The New York Times of January 8, 2015. Consider the following quotes from that article:

“From a health perspective, the annual physical exam is basically worthless. In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.”

On January 18, the Times published some letters from readers which included the following (which makes some good points but still does not address the real issues I cover above:

“To the Editor” “Skip Your Annual Physical,” by Ezekiel J. Emanuel (Op-Ed, Jan. 9), has caused an uproar in my internal medicine practice. When patients call to cancel their annual physical, I must explain that while Dr. Emanuel may be correct that studies don’t show how exams reduce mortality, the annual physical is about so much more.

First, it provides an opportunity to check and counsel on weight and blood pressure — crucial since one out of four deaths in the United States is from heart disease.

Second, we measure height. Shrinkage correlates with osteoporosis, which, if left untreated, is associated with significant disability and death.

Third, we order cancer screening tests.

Fourth, we ensure that patients are up to date on their vaccines.

Fifth, the physical fulfills my office’s requirement of a once yearly visit for any patient receiving prescriptions.

Finally, though Dr. Emanuel mentions it only briefly, the most important part of the annual physical is the strengthening of the doctor-patient relationship. The better I know my patients, the better I can care for them.

The last point would have been especially relevant if the authors had underscored the importance of issues of toxicities of nutrition, environment, and thoughts.

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