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General medical examination

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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.

Contents

Evidence does not support its use by the general population.

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). 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. People who undergo yearly medical exams however are more likely to be diagnosed with medical problems.

Some notable health organisations recommend against annual examinations. 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.

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. Evidence supports several of these individual screening interventions. 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. A recent study found that the examination is associated with increased participation in cancer screening.

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. Despite guidelines recommending against routine annual examinations, many family physicians perform them. A fee-for-service healthcare system has been suggested to promote this practice. An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient. This means choosing between a wide variety of tests.

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. Disadvantages cited include the time and money that could be saved by targeted screening (health economics argument), 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.

Prevalence

It is commonly performed in the United States 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. 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. 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. Several studies have been performed before current evidence-based recommendation for screening were formulated, limiting the applicability of these studies to current-day practice.

References

General medical examination Wikipedia


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