05/10/2020
"In fact, almost nothing in the complete annual physical examination is based on evidence."
"Why, then, do we continue to examine healthy patients? First of all, we get paid to do it. For an annual wellness visit for an 85-year-old, Medicare pays approximately $111. More important, all the tests and treatments my father received, including his hospitalization, generated substantial “downstream revenue” for the health system. Second, patients expect it. We have educated them about the importance of a thorough physical. Without it, patients may leave thinking, “The doctor didn’t even examine me!” Finally, there is our own anxiety about missing something life-threatening. At each step of the process, my father’s physicians’ anxiety increased, in an unstoppable cascade that almost killed him.
"The solution requires that health professionals and payers address each of these root causes ... Most important, we need to educate ourselves about the dangers of overdiagnosis and to suppress our own anxieties. There will always remain a small possibility that our examination might detect some silent, potentially deadly cancer or aneurysm. Unfortunately for our patients, these serendipitous, life-saving events are much less common than the false-positive findings that lead to invasive and potentially life-threatening tests."
In this narrative medicine essay, a physician reflects on his father’s experience, at the age of 85 years, of getting a physical examination from a new primary care physician that ended up setting off a cascade of examinations and treatments.
