The Annual Physical: What Do You Think?

The following is a guest post by Anne Polta, an outstanding writer and author of the blog HealthBeat.  Please check out her work.  

 
Do annual visits to the doctor make sense? Are people healthier when they receive yearly checkups, or is the yearly visit something we do mostly because we think we’re supposed to?

There’s a fair amount of debate in the medical world about the value of that time-honored custom, the annual checkup. Many experts question whether it’s really necessary to subject healthy, asymptomatic adults to a battery of one-size-fits-all tests that might or might not be helpful.

As long ago as 1989, the U.S. Preventive Services Task Force, an independent panel of experts that weighs the evidence and issues recommendations on the use of screening and preventive health care services, found insufficient proof to endorse the benefits of the standard yearly checkup for otherwise healthy adults.

The task force has not suggested that people can skip seeing a doctor unless they’re sick.   Rather, guidelines by the USPSTF, researchers and other physician groups increasingly have tilted in favor of individualized assessment and counseling based on the patient’s age, gender, risk factors, health history and preferences.  In other words, EKGs don’t need to be administered to every middle-aged person who comes in for a physical, nor does everyone need to have annual chest X-rays or a comprehensive blood panel unless there’s a reason for doing so.

This isn’t always an easy message to convey, especially to an American public who’s accustomed to being told to get screened for everything.

The whole issue, in fact, is more nuanced than it appears.   When a group of researchers undertook a review a few years ago of the evidence on the pros vs. cons of the routine physical, the results were mixed.   In their findings, published in 2007 in the Annals of Internal Medicine, the researchers reported consistently clear benefits for regular cholesterol screening, gynecological exams, Pap smears and fecal occult blood testing.   Regular physical exams also appeared to be reassuring for patients.   But the benefits were less clear on other measures, such as whether regular checkups resulted in better clinical outcomes, fewer hospitalizations or lower health care costs.

Why, then, do we continue to have regular checkups, and why do most doctors continue to believe they’re an important part of health care?   The real benefit, it seems, lies in the intangible things: the opportunity for doctor and patient to get to know each other and to develop a relationship when the patient is well rather than sick or in the middle of a crisis.

Dr. Steven Reznick, who has a concierge practice in Boca Raton, Fla., tackled this very issue last week in a guest essay at Kevin, MD. “Is it cost-effective? Does it prevent disease? It doesn’t matter,” he wrote. “  It is an essential part of the development and continuation of the doctor-patient relationship.”

It’s also a way to benchmark the patient’s health from one year to the next and address important issues such as previous illnesses, family history and lifestyle, Dr. Reznick writes.

What Some Patients Really Think About Their Doctors? How To Make Lemonade Out Of Lemons.

I highly recommend you take a look at “10 dumb things you do at the doc’s office.”  Be sure to scan the article…but what you really need to look at is the “comments”…all 700+ of them.

While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments.  A lot of people feel disrespected by their doctors…and they are pretty angry.

Here’s what patients (including a lot of former patients) had to say.  I attempted to summaries the comments by category and included the top five categories of comments below.

#1 – Being on time is a two way street – patients are expected to be on time for their appointments – why aren’t physicians expected to be on time.   Doctor’s think and act as if their time is more valuable than the patient’s time.

#2 – Listen to what I have to say.  “Doctors should realize that many patients have more life experience and have done more research about a condition and drug and may possibly know more than them. God forbid!”  “If you do not like listening to your patients and getting proper information from them, you are in the wrong business.”

#3 – “Don’t just hear one or two of my complaints.   You try telling the doctor all the problems you have and the doctor stops you mid-way, telling you that he or she will take care of two and to come back again for other issues!”  “What about someone like me who is on disability for a multitude of health problems?  What then?”

#4 – “Treat the patient like a sentient human being instead of a lump of potatoes and you will get intelligent patients.”

#5 – Let the patient ask a few questions ok?   I’d ask more questions if I wasn’t treated like I was a crazy hypochondriac or an idiot every time I did.

Too be sure there were a handful of supportive patient comments…even a few physicians tried to explain themselves…but these folks were quickly shouted down by the mob.

What Does It All Mean For Physicians?  What Can/Should Physicians Do?

Based upon my 20+ years of experience working in health care marketing here’s is what I recommend:

• Realize that patient satisfaction surveys often do not tell the whole story.  That’s because people who are really dissatisfied will not waste the time telling you.   Rather they will go on to tell 10 other people how bad you are.

• Evaluate these patient comments in the context of your own practice.  You alone know if any of these comments consistently apply to your practice.   I doubt very much that these patient comments were coming from patients in physician-patient relationships characterized by strong, trusting physician-patient communications.

• Most of these comments seem to come out of anger at having been disrespected in some way.  I you have patients like this, simply acknowledge that you know this has been a problem in the past, that you are sorry, and will try and do better.  Then really try to improve.

• Talk to your patients about their experiences in your practice.  Just ask patients how you are doing…and then follow-up with meaningful change.   Don’t ask if you really don’t care.

• Turn lemons into lemonade.  The fact is that many patients find themselves in sub-optimal physician-patient relationships.   Given the dismal experience everyone is having, why not strive to stand out from the pack by providing an exceptional experience.   It should be relatively easy.

I’ll close with my favorite patient comment:

“Doing exactly what your doctor told you to do.  It’s the number 3 killer according to The New England Journal of Medicine and JAMA.”

That’s what I think.  What are your thoughts?

Where Does The Patient’s Responsibility For Their Health Begin? Do We Know?

When you or I visit an accountant, a lawyer or car mechanic, we know what our role is and have a pretty clear understanding of what the ” expert” is supposed to do. But when it comes to a trip to the doctor these days the roles and responsibilities of patients and physicians have become blurred and unpredictable…and the patient seems to generally be on the losing end.

Take my Mom’s case. My Mom who was 89 years old and evidently had severe osteoarthritis. She never knew that even though she was been seen every couple of months by her Internist for years and years. It’s too bad…because my Mom died last week from complications due to a compressed fracture of her spine. Turns out her spine was very fragile according to her consulting Neurosurgeon but no one ever told her.

The first question that entered my mind when I heard of her condition was why didn’t her primary care physician “pick up” on the severity of her condition before she fell and fractured her spine?

From my perspective, my Mom’s primary care physician should have told/warned her as to the severity of her condition. As it was, she was never prescribed any medications or dietary supplements nor was she advised of the benefits of staying active.

My wife says my Mom should have been aware of the fact that older women routinely experience bone loss. After all, there are ads everywhere warning of the perils of osteoporosis and the benefits of staying active.

So how are patients supposed to know what they are supposed to know?

Is it common practice for physicians to assume their patients have a certain level of health knowledge? If so, is there a difference between expecting patients to understand the perils of smoking versus the perils of bone loss? I was not aware that compression fractures of the spine were so common among women with osteoarthritis. I bet most non-physicians aren’t aware of this fact either.

Where is the dividing line between what patients are supposed to know versus what physicians have an obligation to tell them?

I am all for have people take more responsibility for their health. I understand that physicians can not possibly handle the competing demands they face and that patients have to do more. The problem is that it seems that someone should tell the patient!! If physicians expect patients to take on more responsiblity for their health then why not explain that to patients? But simply telling patients they have to do more is not enough…patients need to be taught what they need to know and what they need to do.

This problem seems to be particularly acute for the elderly. Having grown up before the age of patient empowerment, they generally do what they are told by their physician. If something is important, they believe that their physician will tell them. Unfortunately the rules have changed and I fear that patients are the last to figure it out…often when it’s too late.

Going forward I hope doctors and patients start having frank, honest discussions about expectations and responsibilities. Yes it may take a minute or two…but in the long run it should save lots of time, pain…and yes even prevent accidental falls and untimely deaths.

That’s what I think. Please share your thoughts and experiences…don’t be afraid to disagree.