Blog | Friday, July 16, 2010

The best-laid (follow-up) plans

This post by John H. Schumann, FACP, appeared at GlassHospital.

My friend's 92 year-old grandmother goes to see her eye doctor.

"Everything looks great," he reassures her.

"When should I come back?" she wants to know.

"Two years."

Now that's positive thinking.

* * * * *

This funny story raises an interesting question. When should you go back to see the doctor? Turns out like a lot of things in medicine, it's a bit of hocus pocus mixed with tradition. Perhaps with a tiny pinch of scientific evidence thrown in.

If you have no chronic medical problems (e.g. diabetes, high blood pressure, etc.), do you see your doctor once a year?

Should you?

There's debate about the value of annual physicals. I fall clearly into the middle of the road, "Get 'em if you want 'em" camp--but I don't think they're at all mandatory. In my experience, however, there is some clear psychological benefit to people of a certain mindset: Getting an annual physical makes them dutifully able to check something off their list and perhaps allay anxiety for another year.

Ironically, it's usually the healthiest people (i.e. those least in need of medical care) who report for annual physicals. Hmmmm, maybe there's some correlation there.

The extremes of the annual physicals question [from the doctors' camp] are:

  1. Absolutely. It's a great chance to catch up with your patients and discuss new health issues that arise, take advantage of evolving medical science, and achieve age-appropriate preventive care. [Don't call it 'preventative' care.]
  2. Since there's no medical evidence for the annual physical itself (and under current health care financing, it's poorly reimbursed), scrap the idea.

As far as patient viewpoints, there are also two camps:

  1. It's a must. I swear by it, and could tell you about my uncle/cousin/brother/neighbor/fill in the blank who had some horrible thing discovered at his/her annual physical.
  2. I only go to the doctor when something is a tad amiss. "If it ain't broke, don't fix it."

Most experts agree that scientific evidence in favor of physicals is downright skimpy. Nevertheless, research shows that about two-thirds of surveyed adults think there's value in an annual physical with a doctor. This makes it seem as though it's a habit that will die hard. And advocates of behavior change suggest using the annual visit as a means of improving health through diet and exercise--since there's so little time to do that at other visits.

There are a few key evidence-based age appropriate vaccinations and screening tests that are recommended by multiple authorities. To learn about those, you can read about them, or use my colleague Dr. Nundy's online checklist.

Of course, you can always visit the doctor, too. Just don't be put off if we tell you to come back "when you feel like it."

John Henning Schumann is a general internist in Chicago's south side, and an educator at the University of Chicago, where he trains residents and medical students in both internal medicine and medical ethics. He is also faculty co-chair of the university’s human rights program. His blog, GlassHospital, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people that inhabit them.