Yearly check up: Annual physicals are the ideal opportunity for patients to discuss any niggling health issues they have. *iStock photo
Yearly check up: Annual physicals are the ideal opportunity for patients to discuss any niggling health issues they have. *iStock photo

For most healthy adults, having an annual physical is not critically important.

The annual physical is not as important as a healthy diet, regular exercise and an annual dental check, not as important as having smoke detectors installed in your house and checking them every three months or having the brakes, steering and tyres of your car checked yearly.

Having said that, are annual medicals useful? As a doctor, I find them very useful. It gives me a chance to review a patient’s medications and check for interactions and side effects.

I also have a chance to explain how they work and answer questions about treatment. I can update the patient’s family history, weight, blood pressure, smoking and alcohol habits and offer help where needed.

There is also time to ask specific questions about symptoms which might lead to the early detection of treatable illnesses.

A physical exam follows, and any age appropriate screening tests are scheduled. If the patient has jotted down a list of questions and concerns, we will have the opportunity to address each one.

Patients often use this opportunity to express concerns about family members and seek advice.

Yes, much of this could be done when a patient comes in with a twisted ankle or a sore throat, but often there is not the time or inclination to do so.

Thus, because I find it useful, I offer an annual physical to all patients. I am just as happy to do them every other year. So as a doctor, I find annual physicals useful.

What about patients? Do they find annual physicals useful? Helpful?

I believe that unless the patient leaves the appointment feeling that the visit was useful, then the only person to have benefited was the doctor and that is not the purpose of the visit.

It is important that the patient goes to the annual physical with an idea of what they want to discuss and ask, and be open to suggestions about their health.

Do annual physicals make people healthier? Only if the visit leads to a change of behaviour, such as losing weight, quitting smoking, and so on.

Do annual physicals save lives? No. Does having an annual physical mean that you will be guaranteed to be healthy for the next year? No.

Do annual physicals lead to increased health care costs? Definitely. So if an annual physical is not very important to the average healthy adult, what is?

It is important to be registered with a doctor and have an initial visit. The doctor will ask about the patients past medical history and family history.

The patient should ask how often he or she should be seen and about when screening tests should begin.

The patient should know how to contact the doctor, office opening hours, out of hours contact information, and so on.

It is also important that patients schedule an appointment if things change. For example, if a family member is diagnosed with high cholesterol, if the patient is taken ill abroad and the local doctor does not know he or she has been started on a new medication.

People with previously diagnosed illnesses should discuss with their doctor how often they should schedule an appointment, for example, three months for most diabetics, with one of those visits being a longer ‘full medical’ and every three‐to-six months for most people with well‐controlled hypertension. People with a family history of certain medical conditions — especially if relatives have been diagnosed at a young age — should also sit down with their doctor and discuss how often they should schedule a check up.

In reality, most patients do come in to their doctor’s office at least once a year for one reason or another.

This presents the opportunity to do a quick check up and recommend a longer appointment for a physical, if required.

Here in Bermuda, we have been spoilt. Until recently, the vast majority of adults have been employed and/or fully insured.

Most local insurance companies pay for a well woman check every year and for annual physicals every other year until age 40 and annually thereafter.

In these hard economic times, and with a serious attempt being made to control health care costs, this is likely to change.

We are now seeing increased rates of unemployment and large numbers of patients with no medical insurance or with more minimal coverage.

Doctors and patients alike will need to bear this in mind when making decisions about spending time and money on annual physicals.

At the same time, prevention is always more cost effective than treatment, and preventative health care and patient education must not be forgotten. Doctors need to incorporate more preventative care into regular patient appointments, and patients need to make healthy lifestyle choices top priority.