General medical examination

The general medical examination is a common form of preventive medicine involving visits to a general practitioner by well feeling adults on a regular basis. This is generally yearly or less frequently. It is known under several other names, such as the periodic health evaluation, annual physical, comprehensive medical exam, general health check, or preventive health examination.

Evidence does not support its use by the general population.[1][2]

The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer, or regular visits for people with certain chronic medical disorders (for example, diabetes).[3] The general medical examination generally involves a medical history, a (brief or complete) physical examination and sometimes laboratory tests. Some more advanced tests include ultrasound and mammography.

Evidence

Although annual medical examinations are a routine practice in several countries, it is poorly supported by scientific evidence in the majority of the population. A 2012 Cochrane review did not find any benefit with respect to the risk of death or poor outcomes related to disease in those who received them.[2] People who undergo yearly medical exams however are more likely to be diagnosed with medical problems.[2]

Some notable health organisations recommend against annual examinations.[4][5][6] The American Cancer Society recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20.[7]

A systematic review of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol screening, and faecal occult blood tests) and less patient worry.[3] Evidence supports several of these individual screening interventions.[8][9][10] The effects of annual check-ups on overall costs, patient disability and mortality, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive.[3] A recent study found that the examination is associated with increased participation in cancer screening.[11]

The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge.[12] Despite guidelines recommending against routine annual examinations, many family physicians perform them.[13] A fee-for-service healthcare system has been suggested to promote this practice.[14] An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient.[5][15][16] This means choosing between a wide variety of tests.[17]

Most surgeons ask patients about recent general medical examination results in order to proceed with surgery [1] even though there are arguments for and against most screening interventions. Advantages include detection and subsequent prevention or early treatment of conditions such as high blood pressure, alcohol abuse, smoking, unhealthy diet, obesity and cancers. Moreover, they could improve the patient-physician relationship and decrease patient anxiety. More and more private insurance companies and even Medicare include annual physicals in their coverage. Some employers require mandatory health checkup before hiring a candidate even though it is now well known that some of the components of the prophylactic annual visit may actually cause harm. For example, lab tests and exams that are performed on healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be “false positives” — that is, when test results suggest a problem that doesn’t exist.[18] Disadvantages cited include the time and money that could be saved by targeted screening (health economics argument),[19] increased anxiety over health risks (medicalisation), overdiagnosis, wrong diagnosis (for example Athletic heart syndrome misdiagnosed as Hypertrophic cardiomyopathy) and harm, or even death, resulting from unnecessary testing to detect or confirm, often non-existent, medical problems or while performing routine procedures as a followup after screening.[20][21][22]

Prevalence

It is commonly performed in the United States, the United Kingdom and Japan, whereas the practice varies among South East Asia and mainland European countries. In Japan it is required by law for regular working employees to check once a year, with a much more thorough battery of tests than other countries.

History

The roots of the periodic medical examination are not entirely clear. They seem to have been advocated since the 1920s.[23] Some authors point to pleads from the 19th and early 20th century for the early detection of diseases like tuberculosis, and periodic school health examinations.[24] The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine.[14][24][25][26][27] Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.[3][28][29]

References

  1. ↑ Si, S; Moss, JR; Sullivan, TR; Newton, SS; Stocks, NP (Jan 2014). "Effectiveness of general practice-based health checks: a systematic review and meta-analysis.". The British journal of general practice : the journal of the Royal College of General Practitioners 64 (618): e47–53. doi:10.3399/bjgp14x676456. PMID 24567582.
  2. 1 2 3 "General health checks in adults for reducing morbidity and mortality from disease". Oct 17, 2012. doi:10.1002/14651858.CD009009.pub2. Retrieved 18 October 2012.
  3. 1 2 3 4 Boulware LE, Marinopoulos S, Phillips KA, et al. (February 2007). "Systematic review: the value of the periodic health evaluation". Ann. Intern. Med. 146 (4): 289–300. doi:10.7326/0003-4819-146-4-200702200-00008. PMID 17310053.
  4. ↑ US Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the Preventive Services Task Force 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
  5. 1 2 "Periodic health examination: a guide for designing individualized preventive health care in the asymptomatic patients. Medical Practice Committee, American College of Physicians". Ann. Intern. Med. 95 (6): 729–32. December 1981. doi:10.7326/0003-4819-95-6-729. PMID 7305155.
  6. ↑ Hayward RS, Steinberg EP, Ford DE, Roizen MF, Roach KW (May 1991). "Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force". Ann. Intern. Med. 114 (9): 758–83. doi:10.7326/0003-4819-114-9-758. PMID 2012359.
  7. ↑ Mettlin C, Dodd GD (1991). "The American Cancer Society Guidelines for the cancer-related checkup: an update". CA Cancer J Clin 41 (5): 279–82. doi:10.3322/canjclin.41.5.279. PMID 1878784.
  8. ↑ Screening for Lipid Disorders in Adults, Topic Page. June 2008. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspschol.htm
  9. ↑ Screening for Colorectal Cancer, Topic Page. July 2002. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm
  10. ↑ Screening for Cervical Cancer, Topic Page. January 2003. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm
  11. ↑ Fenton JJ, Cai Y, Weiss NS, et al. (March 2007). "Delivery of cancer screening: how important is the preventive health examination?". Arch. Intern. Med. 167 (6): 580–5. doi:10.1001/archinte.167.6.580. PMC 3443471. PMID 17389289.
  12. ↑ Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ (May 2002). "Public expectations and attitudes for annual physical examinations and testing". Ann. Intern. Med. 136 (9): 652–9. doi:10.7326/0003-4819-136-9-200205070-00007. PMID 11992300.
  13. ↑ Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ (June 2005). "Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers". Arch. Intern. Med. 165 (12): 1347–52. doi:10.1001/archinte.165.12.1347. PMID 15983282.
  14. 1 2 Gordon PR, Senf J (May 1999). "Is the annual complete physical examination necessary?". Arch. Intern. Med. 159 (9): 909–10. doi:10.1001/archinte.159.9.909. PMID 10326933.
  15. ↑ Lawrence RS, Mickalide AD (April 1987). "Preventive services in clinical practice: designing the periodic health examination". JAMA 257 (16): 2205–7. doi:10.1001/jama.257.16.2205. PMID 3560403.
  16. ↑ Frame PS, Carlson SJ (February 1975). "A critical review of periodic health screening using specific screening criteria. Part 1: Selected diseases of respiratory, cardiovascular, and central nervous systems". J Fam Pract 2 (1): 29–36. PMID 1123583.
  17. ↑ Beck LH (November 1999). "Periodic health examination and screening tests in adults". Hosp Pract (Minneap) 34 (12): 117–8, 121–2, 124–6. doi:10.3810/hp.1999.11.175. PMID 10616549.
  18. ↑ "A checkup for the checkup: Do you really need a yearly physical? - Harvard Health Blog". Harvard Health Blog. Retrieved 2015-11-02.
  19. ↑ Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL (April 2003). "Primary care: is there enough time for prevention?". Am J Public Health 93 (4): 635–41. doi:10.2105/AJPH.93.4.635. PMC 1447803. PMID 12660210.
  20. ↑ Yahr, Emily (2015-01-28). "What went wrong with Joan Rivers’s last medical procedure: lawsuit". The Washington Post. ISSN 0190-8286. Retrieved 2015-11-08.
  21. ↑ "Minnesota teen Sydney Galleger dies after dental procedure". www.cbsnews.com. Retrieved 2015-11-08.
  22. ↑ "Three Georgia boys die unexpectedly after dental procedure". www.cbs46.com. Retrieved 2015-11-08.
  23. ↑ Emerson H (1923). "Periodic medical examinations of apparently healthy persons". JAMA 80: 1376–1381. doi:10.1001/jama.1923.26430460003011.
  24. 1 2 Han PK (November 1997). "Historical changes in the objectives of the periodic health examination". Ann. Intern. Med. 127 (10): 910–7. doi:10.7326/0003-4819-127-10-199711150-00010. PMID 9382370.
  25. ↑ Charap MH (December 1981). "The periodic health examination: genesis of a myth". Ann. Intern. Med. 95 (6): 733–5. doi:10.7326/0003-4819-95-6-733. PMID 7030166.
  26. ↑ Davis AB (1981). "Life insurance and the physical examination: a chapter in the rise of American medical technology". Bull Hist Med 55 (3): 392–406. PMID 7037084.
  27. ↑ Jureidini R, White K (2000). "Life insurance, the medical examination and cultural values". J Hist Sociol 13 (2): 190–214. doi:10.1111/1467-6443.00113. PMID 18383634.
  28. ↑ Olsen DM, Kane RL, Proctor PH (April 1976). "A controlled trial of multiphasic screening". N. Engl. J. Med. 294 (17): 925–30. doi:10.1056/NEJM197604222941705. PMID 1256483.
  29. ↑ Knox EG (December 1974). "Multiphasic screening". Lancet 2 (7894): 1434–6. doi:10.1016/S0140-6736(74)90086-5. PMID 4140342.

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