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August 20, 2013

The case against the annual checkup

Today, approximately 177,000 Americans will visit a doctor, even though they have absolutely no symptoms. There is no standardized procedure for the annual health exam. Some doctors limit themselves to a brief interview and a once-over with the stethoscope. Others add-on some useful, or at least arguably useful, preventive health procedures like mammograms, cholesterol checks and prostate-specific antigen tests. Many order a series of laboratory tests that are unnecessary and often counterproductive in healthy adults, like a complete blood count or urinalysis.

The annual health exam is a venerable tradition, stretching back to the late 19th century — those heady days of medicine when doctors overestimated their own ability to cure disease, and badly underestimated their tendency to cause it. We're now in the evidence-based era of medicine, and there's little evidence that annual exams provide any benefit. So here's a free bit of advice: If you're not sick, don't go to the doctor.

There are two kinds of arguments against the adult annual health checkup. The first has to do with the health care system overall, and the second has to do with you personally.

Annual checkups account for more than 8 percent of doctor visits and cost the health care system $8 billion annually — more than the total health care spending of several states. Each visit takes around 23 minutes, which means doctors in the United States spend approximately 17 million hours each year running their stethoscopes over 45 million completely healthy people.

It's important to separate preventive care from annual checkups. Only one-half of annual checkups actually include a preventive health procedure such as a mammogram, cholesterol testing, or a check for prostate cancer. (Annual gynecological visits are excluded from these numbers, although the evidence supporting those is not particularly overwhelming either.) More importantly, only 20 percent of the preventive health services provided in the United States are delivered at annual checkups.

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