Q: My doctor says that I no longer need a physical every year. Why the change? I worry something might get missed.
We’ve known for years that annual physicals do not actually improve people’s health. There’s no benefit to booking a 45-minute appointment so that a doctor can listen to your chest, or poke and prod you in the stomach, when you’re feeling fine. For that reason, many provincial health plans have stopped paying physicians to perform them.
That doesn’t mean you shouldn’t be seeing your doctor to talk about wellness. If you’re in your 40s, for instance, you should have your blood pressure checked once a year and make sure your immunizations are up to date. If you have a family history of colon or breast cancer, you should be coming in to talk about screening. And we could all benefit from semi-regular chats about the latest evidence on diet, exercise and stress. But these kinds of check-ins don’t have to happen within the constraints of a long, rambling “physical.”
Ideally, both patients and doctors should view every appointment as an opportunity for health promotion and disease prevention. For instance, if you’re going in for something relatively minor, it’s a good time to check to see if you need, say, a Pap smear or tetanus shot. If you do, and there’s time, it should be done right then and there.
Some practices are even getting patients to fill out questionnaires in the waiting room, to screen for conditions like depression, addiction and social isolation while they wait to be seen for something else. You’re already sitting there, so why not?
If a patient is suffering from a complex problem that demands a lot of focused attention, however, it’s not always easy to squeeze in questions about general wellness. In these cases, it may be better to book a separate appointment to cover home life, stress management and exercise and to check on the need for screenings. But we don’t need to think of it as an annual physical — it’s more like a preventive health visit, in which the doctor reviews your file and asks targeted questions relevant to your age, stage of life and personalized risk factors. Think of it as the “enlightened physical” — a personalized assessment just for you. It takes much less time, it’s more effective, and you may not even need to change into a hospital gown to do it.
Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.