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Tuesday, December 20, 2022

Is the Annual Wellness Visit just a condescending waste of time or something worse?

 Is the Annual Wellness Visit (AWV) merely a demeaning waste of time or something actually harmful.? I have endured an AWV for the past 4 years, although it was only recently that I  realized what that irritating waste of time was called. For a friend of mine it may have been worse than just a waste of time and the money paid for parking at the large "not for profit" medical center where he PCP practiced.

I think the AWV should be considered potentially harmful to the extent it make take the place of the annual assessment by an internist, as assessment which by long standing tradition included a physical examination.Think opportunity cost/

Some internists , I have no way of knowing how many. have given up on the annual physical exam because the AWV pays better. Medicare does not pay for a routine physical exam. The traditional system review has been replaced by some version of a geriatric assessment exercise in the AWV.

 Annually  as part of his AWV BK an ,81 year old retired dentist, has  been asked about the frequency of falls, if he can prepare his  own foods and if he  can manage his  own finances. BK was asked to draw a clock and to remember three things for a few minutes.He was admonished about the value of the shingles shot,the pneumonia shot and the annual flu shot.He endured the AWV for three years..

No one noticed the mass in his thyroid which grew to the size of 5.5 cm X 3.5. X 3.5 before it was noticed on a CT exam of the cervical spine,ordered by a neurologist as part of a workup for a diagnosed peripheral neuropathy.

The tumor has been removed and the treatment was followed up by radioactive iodine treatment and currently there  is no  evidence of extra-glandular spread but you have to wonder whatever the prognosis is it surely would have been better if some time in the last  3 years the board certified internist who BK calls his primary care physician would have bothered  to  feel his  patient's thyroid gland . 

.Actually had he looked  up from his computer screen in year 3 exam he could have seen the bulge in the retired dentist's neck. The mass was large enough to deviate the trachea to the left. The first element of the physical exam about which he learned in medical school was Observation. It seems that at least some number of internists have given up on what used to be one of their " super powers"  the careful skilled physical examination to take part in the charade of the AWV.

The retired dentist's adventures in a large "non for profit" hospital system centered on how it took almost 6 months for the thyroid cancer to be diagnosed and treated and offers alarming insights into how corporate medicine and the electronic health record (EHR) have changed the practice of medicine and I plan to blog about details of all of  that which have been shared with me in  the near future.Warning spoiler alert -the internists,the radiologists and even the always with the final answer pathologists have little to be proud about.