Some medical doctors are saying annual checkups are not only ineffective, but could negatively impact patients. Neil Bell, a University of Alberta family physician and a former member of the Canadian Task Force on Preventive Health Care, said annual physical examinations don’t actually improve health outcomes. “The annual checkup was created over 100 years ago to help find diseases early and treat them,” he said. “But looking at the results, we’ve found that the annual checkup has little benefit to the patient.” In November the task force published an article in the online journal Canadian Family Physician. In the article they called for an end to the annual physical exam. Instead the Canadian Task Force on Preventive Health Care is recommending physical examinations to be age-specific. For healthy people, the task force is suggesting a complete physical to take place every three to five years. In the article, the Canadian Task Force on Preventive Health Care looked at trials dating back to the 1960s and found that yearly exams didn’t have any clear benefits. The annual exam was created in the 1920s in order to diagnose and treat diseases before the patient would die as a result of them. What the results showed was that the annual exam did little to impact mortality rates. Instead, people were being diagnosed at higher rates, but the same amount of people each year died as a result of the diagnosed disease. Bell said yearly exams could actually be harmful to an otherwise healthy individual. “There’s two kind of harms that can happen with screening,” he said. “One is a false-positive and the other is over-diagnosis.” False-positive readings occur when someone gets a positive result for a disease they don’t actually have, causing unwarranted anxiety and stress. Over-diagnosis is a complex concept to understand, but the negative impacts are significant. It happens when an individual is diagnosed with a disease or condition, but the disease or condition would not have caused the patient any harm. For example, an individual could be diagnosed with a cancerous tumour. With over-diagnosis, the cancerous tumour would not have actually harmed the patient, therefore causing time, money and health of the patient to unnecessarily treat it. “If you had never screened it, it wouldn’t have showed up and you wouldn’t have had any symptoms,” he said. “If you’re over-diagnosed then you have all the harms of treatment and you get none of the benefits.” It may be counter-intuitive to not treat cancer, but Bell said it’s one of the issues health professionals are facing when trying to provide the best health care to Canadians. “As we have more sensitive screening tests, we’re picking up things that are much smaller than we used to pick up. What we’re finding is that many of those don’t actually go anywhere or do anything.” He said the biggest challenge still faced when diagnosing cancer is whether or not an individual is being over-diagnosed, or whether they would benefit from treatment. To face the issue, he said the best thing to do is have a conversation with your doctor on the positive and negative impacts of undergoing treatment. From there, the patient can determine what they feel is the best direction for their health. By reducing the number of annual checkups, Bell said more doctors would also be available to help patients. Dr. Ashan Fernando, local primary care physician at the Grandin Medical Clinic, said even though annual full physical exams may not improve health outcomes, it’s still beneficial to schedule regular appointments with your family doctor. “It’s still important to have a regular checkup, but the nature of that checkup would be different than what you might have expected from the past,” Fernando said. He said studies have suggested that routinely getting full exams completed are not effective in reducing morbidity or mortality rates, but focused checkups are. A focused exam would be based on age and health risks. “You can choose which parts of the physical examination are most important for you and which investigation is more important to you for preventative health,” he said. The focused checkup could be mammograms, blood pressure exams or prostate exams to name a few. Certain types of physical exams have changed over the last decade. Pap tests, for example, used to be completed once a year for sexually active women 18 and over. Today women are encouraged to have a pap test once every three years after the age of 25.
