CHICAGO – Current practice guidelines that recommend against routine annual physicals for adults without specific symptoms of illness may not be widely accepted by primary care physicians, according to a study in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Current evidence-based guidelines, developed in the last 20 years, do not recommend a routine annual physical examination and testing for asymptomatic adults, suggesting instead more selective screening based on the patient's personal and family history and overall risk assessment, according to background information in the article. Despite these guidelines, the authors report, a high percentage of the general public desires an annual physical examination and extensive testing. The current attitudes of primary care physicians toward annual physical examinations have not been previously assessed.
Allan V. Prochazka, M.D., M.Sc., of the Denver Veterans Affairs Medical Center, and colleagues conducted a survey of the attitudes and practices regarding annual physical examinations of a random sample of primary care physicians (PCPs) including physicians specializing in internal medicine, family practice and obstetrics/gynecology who were located in the metropolitan areas of Boston, Denver and San Diego.
Of the 783 primary care physicians responding to the survey 65 percent believed an annual physical examination is necessary in addition to seeing patients for acute medical conditions and chronic medical illnesses. "…most (94 percent) believed that an annual physical examination improved the physician-patient relationship and provided valuable time for counseling on preventive health behaviors. Nearly all physicians (88 percent) indicated that they performed annual physical examinations. Seventy-eight percent believed that such an examination was expected by most patients," the researchers report.
"Surprisingly, in view of the current evidence, 74 percent thought that an annual physical examination improved the detection of subclinical illness [illness without symptoms]," the authors report. "Sixty-six percent believed that annual physical examinations are covered by insurance, 63 percent thought they were of proven value, and 55 percent disagreed with the statement that such examinations were not recommended by national organizations."
"It is clear that, despite national organizations no longer recommending annual examinations and lack of evidence supporting routine laboratory testing in asymptomatic individuals, the public desires such examinations and PCPs continue to believe in the value of these examinations," the authors write. "However, the PCPs in this study are very much in favor of the annual physical examination. Thus, there is a lack of concordance between the guidelines and those who would implement the guidelines. This is a critical challenge for achieving national prevention goals, because many of those on the front lines of primary care do not appear to accept the targeted recommendations of the guidelines."
(Arch Intern Med. 2005; 165:1347-1352. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by the Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver.
Editorial: The Annual Physical
Are Physicians and Patients Telling Us Something?
In an editorial accompanying these studies, Patrick G. O'Malley M.D., M.P.H., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and Philip Greenland, editor of the Archives of Internal Medicine, suggest that there are many potential reasons for the discordance between evidence and practice regarding the annual physical examination. "One possibility is that patients and their physicians value something about what the annual physical provides that the evidence has failed to address," they write. "In particular, it may well be that the patient-physician relationship is what is being valued. Meaningful relationships take time, and the current culture of health care does not explicitly value time spent on developing relationships between patients and physicians. … Perhaps the annual physical has become the forum to serve that purpose, in addition to providing opportunities to address the other items of health care not provided by our current standards of visit frequency and time."
"We need a new, up-to-date research agenda to explore the value of relationship-centered care," Drs. O'Malley and Greenland write. "…we think that there may be something valuable to the annual physical that patients and physicians are telling us indirectly, and if we pay heed to this message and explore it, there may be potential for improving the relationship between patients and physicians and ultimately health care outcomes in ways we might not even imagine. First let us study it, before we abandon it on the basis of there being no evidence in support of it. It is still part of our culture, as demonstrated by the nice work of Prochazka et al and others. We need to understand why."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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