Are annual physical exams cost effective?

Scott Hensley at the Wall  Street Journal Health Blog reports on a jolly old elf who got an annual physical, but is dubious that most patients need one:

Should you…[go] to the doctor for a yearly physical too? Some argue that even if your insurer would pay for the privilege, it may be a waste of your time and the country’s precious health resources, especially with the strains on primary care.

[W]e checked in with Ned Calonge, a family doctor and chair of the U.S. Preventive Services Task Force, which issues guidance on stuff like this. The bottom line, he told us, is that there is no study to show that the best way to deliver effective preventive services is through an annual physical. That said, there’s probably no harm in having one either. The most important principle is to make sure people get regular, individualized preventive services appropriate for their risk profile.

I often will get a screening cholesterol during a visit for a cold.  Or I’ll remind a patient they need a prostate antigen test or a mammogram during a visit for a poison ivy rash.  But I really don’t like the “general physical” visit.  Since the visit is not trying to address a specific problem, it is often a meandering encounter with the patient asking for an EKG of very dubious necessity or for me to draw blood to “test for everything you can because I have insurance and it won’t cost me anything”.

Primary care’s value seems to lie in early detection and treatment of disease which is not quite synonymous with that perennial panacea prevention.

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