DR. MOHLER: The annual physical — time to bury another sacred cow
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Men are lousy patients. Male physicians are a subset of the worst! My last “physical” was my pre-Army exam in 1969. My family physician is amazingly tolerant of my failure to show for physicals, but nonetheless I have intermittently felt guilty over the last 40+ years. But now, no more guilt!
A new study performed by the Cochrane researchers (the most discriminating of researchers) summarized 14 trials that involved 183,000 adults. A general health check (physical) was defined as “screening for more than one disease or risk factor in more than one organ system.”
And they found that physicals:
— had no effect on death rates.
— had no effect on serious illnesses, like heart attacks or strokes.
— had no effect on hospitalizations or work absences.
— had no effect on disability or patient worry.
— did increase the number of diagnoses made (hypertension, hypercholesterolemia).
— did increase the use of blood pressure drugs.
— did make patients feel that they were healthier.
And I would add, physicals did add significantly to health care costs and did create consternation on the part of both patients and physicians when tests came back with false positive results.
I would propose that we redirect the resources that we have wasted on “physicals” on evidence-based interventions that we know work!
Immunizations ($5-$10 return on every dollar invested)
Smoking cessation (the number 1 intervention to get healthier)
Counseling about seat belts, contraception (every woman gets pregnant when she wants to be pregnant), helmets, exercise
Screening tests for breast and cervical cancers in selected women who understand the downside as well as the upside of testing.
Screening for high blood pressure, colon cancer
So at your next “physical”:
You keep your clothes on.
Your physician keeps her stethoscope in her pocket.
The agenda includes vaccines, exercise and a discussion of the pros and cons of mammography and colon cancer screening.
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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