Checkups in check?

Getting an annual physical is good for you, right? Don't be so sure, suggests a study published in September in the Archives of Internal Medicine. The study suggests that, for healthy adults, the benefits of an annual physical may not justify the financial cost.

"A lot of doctors don't think physical exams are very helpful," says the author, Ateev Mehrotra, assistant professor at the University of Pittsburgh School of Medicine and a policy analyst at Rand. The president of the American Academy of Family Physicians, Rick Kellerman, agrees: "The annual physical is not necessary."

Neither of these physicians is suggesting that preventive care, which typically comes to patients in the form of screening tests or lifestyle advice, should fall by the wayside. But 80 percent of preventive care occurs during other kinds of office visits, such as an appointment for a minor ailment, the new study found.

There's no need to sweat missing a physical or even several -- as long as your doctor approves and you remain in close communication with him or her, Kellerman says.

In fact, the annual physical is too often a formality that siphons time and money from the health care system without offering definitive improvements for patients in return, argues H. Gilbert Welch, a professor at Dartmouth Medical School.

Mehrotra estimates that more than a third of annual physicals feature potentially unnecessary tests, such as blood cell counts and urinalysis, that cost more than $350 million per year and that haven't been shown to improve health outcomes.

Some doctors even argue that submitting people to a battery of preventive screening tests -- such as the PSA test for detecting prostate cancer and mammograms for young women -- may end up needlessly exposing people to the risks of treatment when the screening tests may be unreliable and treatment may have adverse side effects.

However, doctors skeptical of the annual physical may be in the minority. In a 2005 survey also published in the Archives of Internal Medicine, researchers reported that 65 percent of nearly 800 primary care physicians from Boston, Denver and San Diego believed an annual physical to be a necessity, 74 percent felt that it improved early detection of illness, and 94 percent said it improved patient-physician relationships.

For example, David Bell, medical director of the Young Men's Clinic at New York Presbyterian Hospital-Mailman School of Public Health at Columbia University, warns that seeing the doctor is important even for young healthy people, since doing so can help physicians catch difficult-to-spot problems associated with sexually transmitted diseases, mental health and substance abuse.

Currently, no major North American clinical medical association specifically recommends that healthy adults get a physical each year. Nor is there even a consensus on what exactly a physical should entail. One physician may order a slew of tests, even for outwardly healthy patients, while another may do little more than tap on a knee and call it a day.

However, from the patient's perspective, having a doctor who recommends frequent checkups or a particular screening test can prove invaluable.

The United States Preventive Services Task Force, which was created and is funded by the federal government, provides up-to-date recommendations on whether, when and how often to get screened for various diseases. The task force strongly recommends certain screening tests. (Whether you get them during an annual physical or not is up to you and your doctor to decide. The important thing is that you get them.)

Certain medical organizations, including the American Cancer Society and the American Committee on the Gynecologic Practice, selectively recommend annual tests for particular groups.

Some health screenings shouldn't be skipped

For the following diseases, the United States Preventive Services Task Force states that there are effective screening tests and that people should get them.

Cervical cancer: The task force strongly recommends screening for cervical cancer in women who've been sexually active and have a cervix until the age of 65. However, the panel also points out that there is no direct evidence that annual screening achieves better health outcomes than screening every three years. Most medical organizations in the United States recommend that annual Pap smears be performed until two or three in a row are normal; after that, the interval between screenings may be lengthened.

Colorectal cancer: Men and women 50 years of age or older should get screened for colorectal cancer. According to the American College of Gastroenterology, people should get either a colonoscopy every 10 years or a sigmoidoscopy and a test to detect blood in the stool every five years.

High blood pressure: Adults ages 18 and older should be screened for high blood pressure, but there's no agreed-upon interval between tests. One influential report recommends screening every two years for people who have blood pressure lower than 130/85 and at more frequent intervals for people with higher baseline readings.

Lipid disorders: The task force strongly recommends cholesterol testing in men ages 35 years and older and women ages 45 years and older who have heart-disease risk factors such as diabetes, hypertension or a family history of cardiovascular disease. The task force makes no recommendation for healthy younger adults in the absence of known risk factors for coronary heart disease.

Breast cancer: Women ages 40 or older should get a mammogram every one to two years.

Osteoporosis: Women ages 65 and older should be screened routinely for osteoporosis. (Screening should begin at age 60 for women identified as being at increased risk for fractures.) The optimal interval for repeat screening is not clear, according to the task force.

Tobacco: All adults should be asked by their doctors whether they use tobacco, and smokers should receive an intervention designed to end their tobacco habit.

Alcohol: All adults should receive screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.

Obesity: The task force recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults.

-- U.S. News & World Report