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Danielle Ofri, author and associate professor at New York University School of Medicine and editor of the Bellevue Literary Review, wrote in the New York Times (10/6, Ofri, Subscription Publication, 9.61M) about how physicians find it difficult to change their own habits, including the tendency to order an annual exam for patients with no health complaints. Ofri notes the Choosing Wisely campaign that urges physicians to reduce “overutilized” tests and treatments and admits that some such habits – such as that exam – are hard to break, and that confession could “give us a dose of empathy for our patients, who are struggling with the same challenges when it comes to changing behavior

From the ABIM (American Board of Internal Medicine:)

Don’t perform routine general health checks for asymptomatic adults.

Routine general health checks are office visits between a health professional and a patient exclusively for preventive counseling and screening tests. In contrast to office visits for acute illness, specific evidence-based preventive strategies, or chronic care management such as treatment of high blood pressure, regularly scheduled general health checks without a specific cause including the “health maintenance” annual visit, have not shown to be effective in reducing morbidity, mortality or hospitalization, while creating a potential for harm from unnecessary testing

BLOGFINGER MEDICAL COMMENTARY.  By Paul Goldfinger, MD, FACC

I have a couple of problems with this doctor’s conclusions.   She says that yearly visits to a physician are useless unless they are for treating specific medical problems or for “specific evidence-based preventive strategies.” She says that such visits have not been proven to save lives or reduce morbidity. In addition she says that such health maintenance visits can cause “potential harm due to unnecessary testing”

Some doctors, like this one, like to hide behind “scientific proof” as the be-all touchstone for quality. There is such a thing as a doctor-patient relationship which needs to be nurtured, like watering a plant.   When you sign up with a physician, your expectation is that the doctor has accepted some degree of responsibility for you.  If you are healthy, you expect that he, or his surrogate, will be available in some capacity 24/7 in case you get sick.  And if he is not available, then you and your lawyer might complain of  “abandonment.”

Thus, the doctor who accepts you as a patient has given you a sort of insurance policy. So it is not only unreasonable, but it is bad medicine, for your physician to not interact with you in person at least once per year, even if you feel fine, whether or not some research trial says that such routine visits are useless. Sometimes good judgement needs to prevail.

If you were not allowed to see that doctor because your ACA policy will forbid it, what happens if you develop a large abdominal tumor that was not diagnosed sooner?  Do you think your lawyer will understand why it was missed at an annual exam that never happened?  Will you and your family wonder why your doctor didn’t check you sooner?

Much is made of preventive medicine as a way to reduce healthcare costs and avoid disease, but this doctor says that routine visits are not needed unless prevention efforts have been proven to save lives. Well, just about all of the prevention techniques that we use have been supported by research including: blood pressure, cholesterol, weight, exercise, diet, stress, smoking, some food supplements, and others.  What are the useless ones that she is talking about?  Just about every “healthy” patient can benefit from a discussion of prevention with their doctor once per year.

And as for useless tests, that can happen with her approved visits as well as with her “useless health maintenance visits.”

So my scientifically unproven conclusion is “bull.”