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Do You Really Need an Annual Physical?

5 myths and facts you should know about that yearly checkup

Do you need a physical?

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Among medical experts, opinions are divided about whether physicals are really beneficial for those who are otherwise healthy.

En español | The annual physical exam has been a popular fixture in American medicine since the 1940s, as a way to help your doctor get to know you and your medical history, do some screening tests and maybe even catch some problems early. So you'd think that every health expert would be in favor of it.

And you'd be wrong.

That's just one of the myths about the annual physical — that everyone thinks it's a good idea. There are other things you should know as well, such as whether Medicare covers it. (Hint: It's complicated.)

Check out these five myths:

Of course an annual physical is a good idea.

Well, that depends on whom you ask. Among medical experts, opinions are divided about whether it's really beneficial for those who are otherwise healthy. Among Americans, however, the answer is clear: Ninety-two percent think it's important to get checked out by their primary care doctor once a year, according to a 2015 Kaiser Family Foundation poll, and 62 percent of those polled do go see their doctor annually.

Still, many doctors insist that the annual checkup needs its own checkup.

Last October, the New England Journal of Medicine featured dueling editorials by physicians for and against the annual exam. One side argued that there's no evidence that these exams help Americans stay healthier or reduce deaths, and that basically they waste time and money that could be spent on sicker patients.

The other side disagreed, saying the exams help build a doctor-patient relationship and provide the opportunity for doctors to run some basic but important screening tests.

Another expert, David Himmelstein, a primary care physician and professor at the City University of New York School of Public Health at Hunter College, also is in favor of the yearly exam, especially for those 50-plus.

Himmelstein cowrote an editorial on the subject for the Annals of Internal Medicine in January, pointing out that the commonly cited evidence against annual exams is based on an analysis that excluded studies of older adults.

"Regularly visiting a doctor for older adults is reasonable," Himmelstein said in an interview. "We're quite worried that these [anti-exam] recommendations could make patients become strangers to their doctors or vice versa."

The point of an annual exam is to make sure you're healthy.

Not exactly. An annual exam does give a quick snapshot of your health, but its aim is to focus on commonplace prevention and screening and to help you establish a doctor-patient relationship in case of an illness. Even the physicians who authored the editorial against an annual exam agree that a periodic checkup is important for establishing that relationship and that primary care doctors need to monitor their patients' attention to preventive care.

For example, during an annual exam a doctor should do things like discuss a patient's family medical history for increased risks of heart attack, hypertension, diabetes or cancer; listen to the heart and abdomen; measure blood pressure; and talk about the need for various screening tests like a colonoscopy at age 50 or a Pap test for women, as well as needed immunizations — all subjects that wouldn't come up during a regular doctor visit for a specific problem.

I feel fine. I don't need an annual physical.

Maybe you don't need an exam every year, but "it's important to maintain periodic contact with your physician, especially after age 50," said Marvin Lipman, M.D., chief medical adviser for Consumer Reports.

Besides, you may not even know you're having symptoms. Some serious conditions don't have obvious symptoms, especially in the early, more easily treatable stages — for example, high blood pressure, high cholesterol, diabetes, colon cancer and cervical cancer. A routine checkup by your doctor can include these basic screenings. Doctors can also make sure you've gotten immunizations important for older adults, including shingles, pneumonia and flu shots, Himmelstein said.

Medicare will cover the cost of an annual physical.

Not quite. Medicare covers two types of physical exams: a "Welcome to Medicare" exam when you first sign up, and what is called a yearly wellness visit. You have to ask the doctor's office specifically for the free Medicare wellness visit so that it gets coded correctly on the invoice. Don't just ask for a physical. If you prefer to have a physical, you'll have to pay the doctor's charge yourself unless you have a Medicare Advantage Plan or secondary insurance (such as from a former employer) that covers it. But be aware that Medicare supplemental insurance, known as Medigap, does not cover this cost.

For the Medicare wellness visit, the doctor measures your height, weight, body mass and blood pressure and listens to your heart. You don't even have to remove your clothes. The rest of the visit involves a discussion of the patient's medical and family history, any physical and mental impairments, and risk factors for potential diseases such as diabetes and depression. The doctor may refer the patient for other tests and screenings.

If an exam is free, there's no downside.

Some think there is. For the patient, there's the time and travel to see the doctor, as well as possible "false positive" results from lab tests that could suggest a problem where there isn't one and cause you worry and additional testing, say Harvard physician Ateev Mehrotra and Allan Prochazka of the University of Colorado, authors of the anti-annual exam editorial in the New England Journal of Medicine. They also estimate that annual exams cost the health care system $10 billion a year and take up doctors' time. "Approximately 10 percent of all visits with primary care physicians are for annual physicals, which might be crowding out visits for more urgent health issues," they wrote.

On the other hand, regular free checkups could help more people get recommended preventive services, said Himmelstein in his editorial, and motivate more high-risk and low-income groups to see their doctor.

So who should have an annual physical?

Recommendations vary, but if you're healthy — meaning you don't have a chronic condition and are not taking prescription medicines — the best solution might be to ask your doctor how often he or she wants to see you. And if you don't have a regular primary care provider, a get-acquainted physical exam would be good for establishing a baseline doctor-patient relationship in case you do get sick.

Otherwise, age and being at risk for certain diseases because of a family history could make an annual exam worthwhile. And if you're taking medication for a chronic condition, even if that condition is under control, regular checkups may be warranted.

Best advice: Ask your doctor.

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