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Thursday, June 30, 2005

The annual Physical-often maligned often done anyway

The issue of the venerable physical exam is again addressed-this time in the current issue of the Archives of Internal Medicine. An article gives the results of a survey and an editorial is not quite ready to dismiss it entirely. The article reports that 439 (65%) of the 783 respondents (out of 1679) to a mail survey agreed an annual physical exam is necessary. They felt the exam was useful because;1) the doctors have time to discuss preventive measures, 2) subclinical disease could be detected and 3) it improved the doctor-patient relationship. As with all surveys we never know what the non-respondents think.
The editorial quotes the standard consensus statements from the U.S. and Canada asserting the lack of evidence of any value of the practice but also opines that there may be something worthwhile here since the docs and the patients apparently think it is worthwhile.Maybe there is something to this doctor patient relationship thing.There is evidence in the clinical research literature that the continuity with one physician is valued by many patients and this annual ritual may be one way to keep the relationship fresh.I have done thousands of these and I agree with the editorialist that maybe a better term would be annual health evaluation or consultation. The hands on part may not be the most important but the laying on of hands may have value greater than the occasional basal cell cancer we detect or thyroid nodule we feel but it is part of the package.Most of the time in these encounters is really spent in talking with the patient about what he wants to talk about and about what general preventive issues I think should be discussed.As patients get older particularly the opportunity to sit down with your doctor and talk about whatever, fears, concerns, what you heard on TV is increasingly valuable and I believe my patients have left the office generally feeling better than when they came in. When I see my internist annually, I know I do. It is about time. During this annual "check up" the physician can take time and talk. Time spent implies you care about the patient's complaints or concerns and about the patient. When the doc has a 12 minute limit imposed in his patient encounter the patient cannot help but think Dr. Jones is dismissive. The worse aspect of managed care is that the physician-patient encounter is robbed of time. The annual health consultation may be a mechanism to return some time to the relationship.

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