The first post of this year was (naturally) a resolutions-centric one (I think it’s endearing to be predictable!). The list of to-dos for 2007 in 5 Simple New Year Resolutions For A Fitter, Healthier You! began with the expected items: non-processed foods, fruits, veggies, exercise… you know, the good stuff.

doctorHowever, for #5 I chose to include “Annual Physical Exam” and while some may question whether this is really a “top 5″ item, a recent study published in the Annals of Internal Medicine might just vindicate my choice.

Systematic Review: The Value of the Periodic Health Evaluation is a detailed analysis of PHE (Periodic Health Evaluation is another term for Annual/Regular Physicals) and its benefits and harms, if any. As the study states in the very beginning, PHEs have been a fundamental part of medical practice for decades, despite a lack of consensus regarding its value in health promotion and disease prevention.

For example, opponents of regular checkups cite unnecessary use of medical resources, additional expenses and the use of unrecommended services as some of the reasons to reduce the number of PHEs performed every year.

Defining Periodic Health Evaluation:

The review, however, sought a broader definition of PHEs that could be applied to most clinical practice environments, regardless of patient populations, health care delivery settings, or resource constraints.

We defined the PHE as one or more visits with a health care provider for the primary purpose of assessing patients’ overall health and risk factors for disease that may be prevented by early intervention. […] According to our definition, the PHE did not include the delivery of clinical preventive services that patients could receive during or after their visit for the PHE and that we considered an outcome of the PHE. […] Under our definition, the delivery of clinical preventive services provided both during that visit (such as counseling to stop smoking and a Papanicolaou [Pap] smear) and outside of the visit (such as mammography or colonoscopy) were considered to be a result of the PHE (history, risk assessment, and physical examination) and not part of the PHE.

Sources for the review:

Using these definitios in place, the authors of the review went through previous studies in journals like MEDLINE, Health Tecnology Assessment Database and other National Health System databases published through September 2006, searching for such terms as “annual physical examination” and “periodic health evaluation”. More than 7000 articles were finally narrowed down to 33 studies that were reviewed in detail to obtain the results. To ensure a broad range, these studies were chosen over a period of 3 decades and while two-thirds were performed in the United States, the rest are from countries like Untied Kingdom, Canada and Japan.

Results of the review:

As with any study the results themselves are graded differently based on the type of screening performed at the PHE. Three main groups of results were published:

Clinical preventive services:
High Rating: gynecologic examination, Pap smear and fecal occult blood screening
Medium Rating: evidence on immunizations and cholesterol screening
Low Rating: evidence on counseling and mammography.

Proximal Clinical Outcomes(disease detection, change in patient health-habits):
High Rating: evidence on blood pressure
Medium Rating: evidence on disease detection, health habits, patient attitudes, health status, and body mass index
Low Rating: Evidence on serum cholesterol
The PHE also had a beneficial effect on patient worry (less increase in patient worry over time among persons undergoing the PHE than in those not undergoing the PHE)

Distal Economic and Clinical Outcomes (costs, hospitalization factors):
High Rating: evidence on hospitalization received a high rating.
Medium Rating: Evidence on costs, disability, and mortality

Conclusions:

As can be clearly seen from the results described in the section above, PHEs have great benefits in several areas, particularly:

  1. Blood pressure - probably the most easily preventable disease if detected and treated prompty.
  2. Gynecologic, pap smears and breast exams - probably the most important of regular exams for women that can lead to early detection of various forms of cancer of other diseases.
  3. Cholesterol screenings to ensure supplements or prescription medicine can be recommended in time to prevent the serious effects of high cholesterol like stroke or heart disease.
  4. Health habits and patient attitudes to fitness and nutrition, though moderate are still good enough reasons for a PHE.
  5. Reduction of patient worry - a significant stress-buster. Knowing you are healthy is a great feeling, but knowing your PHE helped you catch something on time and begin treatment that can lead to a full recovery is an even better feeling!

So pay your good doctor a visit at least once a year even if you are feeling perfectly healthy - he/she can help make sure you stay that way.

When do you plan to get your annual physical examination this year?

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