i’m over 55: do i need an annual physical?

For more than 100 years, healthy Americans have regularly visited their doctors for an annual physical exam, rarely questioning the value of the routine. The practice began in the early 20th century when life insurance companies began requiring checkups over the life of a policy. Doctors embraced the idea and patients liked it too. After all, doesn’t it make sense to catch potential problems before they become serious? In the last several years, this practice has come into question. Some studies found that the annual physical doesn’t save lives or reduce hospitalizations, and some suggest that unnecessary tests and procedures put patients at risk and drive up costs. As a result, the role and importance of the annual physical has become questionable.

After several years of debate, the consensus is that while not strictly necessary for young, healthy adults, an annual visit with a primary care physician is indeed advisable. The outcome of the controversy has been not to eliminate the yearly visit but to improve upon it by focusing on wellness, health maintenance, prevention, and the doctor-patient relationship. Patients can get better care when their physicians know then well. Going to the doctor when you are sick doesn’t allow time to develop this relationship. Medicare has re-examined the role of preventive visits for those over 65 and now covers “wellness visits” that focus on health risks, preventative health, mental and physical function, and safety.

Does everyone over 55 need an annual physical?
The advisability of an annual checkup is an individual decision to be made by patient and doctor. With the risk of illness rising with age, most physicians will want to see patients once a year starting at age 55. Anyone with a chronic illness or condition that requires prescription drugs will usually be seen more often. With or without a specific condition, the annual visit is an opportunity to focus on lifestyle issues like diet and exercise, preventive strategies, and periodic screenings.

What about women who see a gynecologist annually?
A gynecological checkup typically includes a breast exam (plus a mammogram), a pelvic exam, and Pap and HPV screening tests for cervical cancer. Many primary care physicians can perform this checkup and some women therefore choose to eliminate the visit to a gynecologist. Others are comfortable seeing both a primary care physician and a gynecologist each year. It’s an individual decision for each woman and her doctor(s).

What is covered in an annual physical?
The details of the exam itself vary from person to person, depending on age, gender, and medical history, but always focus on prevention and screening.

Most annual visits will include many or most of these items:

• Vital signs and statistics like weight and height, blood pressure, and lab tests that measure cholesterol, sugar, thyroid and liver function, and other factors pertinent for the patient.
• Heart and lung check: Not everyone needs an electrocardiogram (EKG) but most doctors will check heart rate and respiratory function.
• Cancer screening for colorectal cancer may begin at age 50 or earlier in the presence of certain risk factors. Women will be screened for breast and gynecological cancers and men, after age 40, for prostate cancer.
• Additional tests such as a bone density scan to check for osteoporosis, total skin exam to check for early signs of skin cancer, eye exam to asses risk for cataracts or glaucoma may be also recommended.
• Preventive counseling includes conversations about drug and alcohol use, smoking, diet, physical activity, mental health, and immunization status.

Today’s annual well-patient visit remains a critical component in taking responsibility for your health and quality of life. It helps foster a relationship with your doctor and focuses on prevention and maintaining a healthy lifestyle.

Lisa Bardack, MD

Dr. Lisa Bardack joined CareMount Medical in 1996 as a full time internist, after been an academic internist at the NY Presbyterian Weil Cornell Medical Center. She loves treating the “whole patient” and is particularly interested in health maintenance and disease prevention through life style modification. In addition to direct patient care, Dr. Bardack also plays an important administrative role at CareMount Medical; she is the chairman of the Department of Medicine and Assistant Medical Director. 90 South Bedford Post Rd; Mount Kisco, NY 10549; 914-242-1370

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