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The debate on yearly physicals rages on. Are they the benchmark of good health or an expensive drain on the health care system?

Dr. Myechia Minter-Jordan, the chief medical officer of The Dimock Center, is clear on her opinion. “It is one of the more key visits,” she said. “It provides an opportunity to focus on the total patient.”

While visits for acute complaints average 20 minutes, Minter-Jordan said she devotes twice that amount of time for a yearly physical. “It’s a more relaxed setting where I can address multiple issues,” she explained.

But a study published in 2007 in the Archives of Internal Medicine suggests that, for healthy adults, the benefits of an annual physical may not justify the financial cost.

Researchers from the University of Pittsburgh School of Medicine and Harvard Medical School found that preventive health examinations and preventive gynecological examinations account for 8 percent of ambulatory visits at an annual cost to the economy of almost $8 billion.

The problem, according to the researchers, is that no professional organization has a set policy on yearly exams and there are no established criteria on exactly what that exam should entail. Physicals vary by doctor and even region of the country. They are most common in the Northeast, least common in the West. Some doctors perform a cursory check, while others examine each system of the body and include blood and urine tests.

In addition, critics argue, screening tests — the hallmark of prevention and the chief component of yearly exams — can actually be performed at other medical encounters during the year. A visit for a rash, for example, can segue into a check for hypertension, cholesterol or even cervical cancer.

Yet, supporters of yearly exams contend that they serve a much broader role than just screening tests. They help establish and cement patient/doctor relationships and set the stage for education and conversation in an unhurried environment.

Minter-Jordan added that it is not the best time to offer screenings when someone is not feeling well.

Regardless of the debate, an earlier study in the same journal found that 65 percent of roughly 800 primary care physicians in Boston, Denver and San Diego agreed that yearly exams were necessary, a sentiment shared by a large number of patients.

The federal government has weighed in. As part of the Medicare Modernization Act of 2003, a “Welcome to Medicare” exam has now been added that consists of seven elements, including functional ability and safety.

The lack of a clear standard on yearly physicals is not a reprieve from doctor’s visits. Quite the contrary. The need for certain screening tests has been well established. Several professional organizations, such as the American Cancer Society, have developed protocol for prevention or early detection of particular illnesses based on research findings.

The ability to stop a disease before it starts or detect it in its infancy is one of the major advances in health care in this country and instrumental in the drop in deaths of many diseases. Cervical cancer rates have fallen as much as 70 percent since 1955 in the U.S. largely due to widespread use of the Pap smear. Women can now find breast cancer before it spreads and a simple, painless blood pressure measurement can warn of the risk of stroke.

Yet, one size does not fit all — the guidelines do not necessarily apply equally to all patients or all clinical situations. Family history or race may dictate earlier or more frequent screening. For instance, because of the higher incidence and lower survival rates of colorectal cancer in African Americans, the American College of Gastroenterology (ACG) now recommends that blacks begin screening at 45 instead of the general guideline of 50. The ACG further recommends a colonoscopy that allows examination of the entire colon rather than a sigmoidoscopy, which provides only a partial view. It has been found that blacks have a higher risk of polyps or tumors on the right side of the colon, a section missed by sigmoidoscopy.

Minter-Jordan stressed the need to tailor the visits to age as well as race and family history. For instance, a discussion around establishing good health practices may be more appropriate for a 20-year-old, while an exam for those 50 years and older will be structured around cancer screening. Elderly people may be more concerned about Alzheimer’s disease, arthritis or limited physical ability.

Myechia Minter-Jordan, M.D.
Chief Medical Officer
The Dimock Center

Thoroughness is the issue here. “I examine from head to toe,” Minter-Jordan said.

She goes system by system, asking questions as she goes: “Do you get headaches, have you gained weight, have you had chest pains?” Peeling back layer by layer helps people recall episodes they may have had and dismissed.

Urine tests checks for protein in the urine, a sign of diabetes and kidney function. Blood tests look for anemia, cholesterol and abnormal kidney function. Screening for diabetes and kidney function is critical for African Americans. The prevalence of diabetes is higher in blacks than in any other racial group, and diabetes is the leading cause of chronic kidney failure, which can result in dialysis or kidney transplantation.

There’s a common misperception that immunizations are just for kids. Not so, according to Minter-Jordan. Adults require protection against tetanus, pneumonia for those over 65, the flu and even the mumps, measles and rubella.

Though a healthy lifestyle — weight control, exercise and healthy eating — may be difficult to manage, it is essential to good health and a key part of her discussion and education. Minter-Jordan has become a cheerleader of sorts. She knows how hard it is to change certain lifestyles, but “I try to boost their confidence,” she said.

Emotional health does not escape notice. “I do a mental health checkup, looking for signs of depression and stress,” she commented. She checks for mood changes or indications of substance abuse and refers patients to mental health counselors as needed.

She is quick to point out that the exams are not one-sided. “It’s a collaboration,” she said. “I like patients to question me. They shouldn’t be afraid to speak up.”

For those who say they do not need a yearly exam because they feel well, she has a ready response: “You don’t feel high blood pressure until it’s too high.”

The key to the exam is trust, according to Minter-Jordan. It provides an avenue to establish a partnership with the patient. After all, she said, “You’re trusting someone with your life.”

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