FORT WORTH, Texas - It's familiar advice for staying healthy: Exercise, eat your veggies, and visit the doctor once a year.
That thinking sends millions of Americans to their physicians' offices for annual physical exams. Yet there's little agreement among doctors about whether regular physicals are actually necessary. Or even about which tests should be included in a routine checkup.
Without such consensus, some employers' health plans are abandoning coverage of annual physicals. At the same time, other businesses are taking the opposite approach - using financial incentives to encourage their employees to have regular exams.
Dr. David Lawson, a past president of the Tarrant County (Texas) Academy of Family Physicians, calls it an "interesting dichotomy" that he sees regularly in his Colleyville, Texas, practice.
"There's some employers that will require that you get a physical. And in fact, they have paperwork for us to fill out saying that they have had the physical, and checked their blood pressure, and checked their cholesterol, and things like that," Lawson said. "There's other insurances that have moved to, instead of having physicals every year, you have physicals every two years. There's some of them that don't pay for physicals at all."
Although routine physicals seem to make common sense, medical experts haven't found clear evidence of any benefits, said Dr. Charles Cutler, who is chief medical director for national accounts at health insurer Aetna.
"For adults, really, there aren't good recommendations," Cutler said. "The old recommendation that you should have an annual physical I don't think applies."
The U.S. Preventive Services Task Force, for example, doesn't advocate routine annual exams. Neither does the American Academy of Family Physicians.
Even so, regular exams remain commonplace, with more than 63 million U.S. adults getting physicals and routine gynecological exams each year for a cost of $7.8 billion, according to a study released last September by researchers at the University of Pittsburgh and Harvard University.
Yet patients actually get 80 percent of preventive health services, such as ordering mammograms, while visiting their doctors at other times. And many patients undergo electrocardiograms, complete blood-cell counts and other unnecessary tests during their physicals, said Dr. Ateev Mehrotra, the study's lead author. Mehrotra would like physicians to reach some agreement to give patients better guidance about how often they should have exams and what services should be included.
The task force recommends a litany of preventive services, especially as people grow older. But the group says there's insufficient evidence to support some commonly used tests, such as chest X-rays to detect lung cancer in symptom-free patients and rectal exams and PSA blood tests to find prostate cancer.
In general, Mehrotra argues that patients don't need a physical as long as they're up-to-date in receiving the age-appropriate preventive services and they've seen a doctor within the last couple of years. "There's nothing magical about this visit itself," he said. "It's about getting those important services."
Lawson, the physician, has a different perspective.
He advises patients in their 30s to have a physical every three years. Those in their 40s should be checked every other year, and people in their 50s need annual exams, he said. The idea is to catch illnesses early before they worsen, he said.
"We know it's much cheaper to treat things up front than treating it through the emergency room," Lawson said.
Johns Hopkins University researchers found some benefit to periodic physicals in an April 2006 study. They concluded that physicals boosted the chance that patients would get Pap smears, cholesterol tests and colon-cancer screenings - reason enough for doing the exams.
Annual checkups also may help patients develop a relationship with a primary-care physician, Aetna's Cutler said.
Marianne Fazen, who is executive director of the Dallas-Fort Worth Business Group on Health, said employers are increasingly focused on getting value for their healthcare dollars. That means promoting good health and seeing verifiable outcomes.
"The annual physical may or may not be the most important thing or have value. But what is most important is getting the preventive tests done," Fazen said. "Whatever the age and gender recommendations are for preventing or reducing the risk for all these costly chronic diseases that everyone's getting, that's what the employers are really supporting."
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(c) 2008, Fort Worth Star-Telegram. Distributed by Mclatchy-Tribune News Service.