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It’s ironic that while many people are avoiding the doctor for fear of what it will cost, some medical experts are debating the value of the one “free” aspect of the Affordable Care Act: an annual physical (a.k.a. preventative exam) and appropriate screening tests.
The annual physical and screening tests are offered with no out-of-pocket expenses for the patient—no deductibles, no copays, no co-insurance—but some studies are calling the annual physical a waste of money. (Some would ask, Whose money—the insurance companies’ money?)
The U.S. Preventative Task Force, a group of experts in prevention and evidence-based medicine (yes, “evidence-based medicine”), was the push behind the Affordable Care Act’s decision to offer no-cost screening tests. The USPTF stopped short on recommending an annual physical, however. Its Canadian counterpart came right out against an annual physical.
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Annual Physical Exam Facts
Neglecting the importance of an annual physical, however, may be shortsighted. The fact of the matter is that you cannot walk into a laboratory or radiology unit and request screening tests without a requisition (prescription) for the service from your physician. Your doctor then has the responsibility of informing you of the results and making recommendations based on those results. If you’re not ill and regularly seeing a doctor, this will be done at your annual physical.
But the Society of General Internal Medicine released a statement in 2016 that an annual physical may not be necessary for every person. The organization cited concerns about overdiagnosis, labeling, and patient anxiety as reasons for not doing an annual physical. Its advice to patients? “Talk with a trusted doctor about how often you need to be seen.”
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Indeed, the statement about talking with a trusted doctor is extremely valuable. Most doctors believe in the annual physical. The Centers for Disease Control and Prevention (CDC) says that preventive care could save 100,000 lives a year.
“Preventive care includes health services like screenings, check-ups (a.k.a. the annual physical), and patient counseling that are used to prevent illnesses, disease, and other health problems, or to detect illness at an early stage when treatment is likely to work best,” according to the CDC. “Getting recommended preventive services and making healthy lifestyle choices are key steps to good health and well-being.”
Samuel S. Badalian, M.D., Ph.D., director of the Gynecology-Urogynecology Center in Syracuse, N.Y., says that the annual physical, often called a well-woman exam, is vital to a woman’s health. “A woman can sometimes go two or three years without a pap smear, but she needs an annual pelvic and breast exam,” he says. “She cannot detect pelvic masses and tumors on her own. She cannot see or feel the areas that need to be palpated for lesions.”
Dr. Badalian says the high out-of-pocket costs from deductibles and copays are causing women to put off seeing the doctor until their “free” annual physical is due. He said one patient waited four months after she first experienced post-menopausal spotting so it could be part of her free well visit. The diagnosis? Uterine cancer.
“I am definitely seeing more well-visit patients who come in with a problem as well than I did three years ago,” says Dr. Badalian. That time frame is the start of the Affordable Care Act, which caused skyrocketing insurance premiums and out-of-pocket costs. People became afraid to go to the doctor due to the cost, so they put it off until the free annual physical. Some people skipped the free annual physical, too, for fear of additional, costly testing.
The Free Annual Physical
We found little to no support from active, practicing physicians against an annual physical. However, the annual physical may not be as horrible as you may fear, if you’re seeing that “trusted doctor.”
The annual physical isn’t as “physical” as you might fear, either. In fact, much of it involves just talking with your physician. No annual physical is exactly the same as others. And, for some of us, the physician may not actually require it annually, but remember that most insurances do cover 100 percent of your annual physical and many screening tests.
An annual physical usually includes:
- A review of family history
- A review of your medical history
- A list of your medications and supplements (prescription and over-the-counter)
- A review of other physicians you are seeing
- Height, weight, calculation of your body-mass index (BMI), respiration, body temperature, and blood pressure
- Simple eye test
- Vaccinations, like tetanus, whooping cough, flu, pneumonia
- Review of your mental state, such as risk of depression
FUTURE ANNUAL PHYSICAL GENETIC SCREENING
Researchers at the University of Texas Health Science Center at Houston (UTHealth) have developed a framework to analyze genetic variations that raise or lower risk of disease. The paper was published in the American Journal of Human Genetics.
Through the framework, researchers were able to identify genes for blood lipid levels, white blood cell count, and a molecule, troponin, that helps diagnose heart attacks. This information could help physicians make stronger recommendations on screening tests you need.
“Whole genome sequencing will become an integral part of routine medicine in the near future,” said Eric Boerwinkle, Ph.D., dean, M. David Low Chair in Public Health and Kozmetsky Family Chair in Human Genetics at UTHealth School of Public Health.
For the physical part of the exam, you can expect your physician to listen to your heart and lungs. He or she will look into your eyes, ears, nose, and mouth. Your reflexes may be checked. Depending upon individual needs, your physician may palpate your abdomen and check your genitalia and rectal area.
A full body scan for skin cancer is not usually done, as the U.S. Preventive Services Task Force stated evidence was insufficient for recommending this. However, a group of dermatologists and oncologists published an article in Future Medicine stating that routine body screening of high-risk people could help reduce skin-cancer deaths.
Men may be subject to a prostate examination; women may have a breast and pelvic exam. These exams may also include a fecal occult blood test, checking for blood in your feces that might indicate cancer or another disease.
Screening laboratory testing usually includes blood tests, like a lipid panel (cholesterol) and metabolic panel (includes blood glucose, a.k.a. sugar, electrolytes, liver function, and kidney function). Some practices will also test your urine, if you’re having any abnormal urinary symptoms.
Screening radiology may include mammogram, chest x-ray, and bone-density testing. The American Academy of Family Physicians advises against physicians ordering annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms. They state there is little evidence to support its use in these circumstances, citing false-positive tests could cause “unnecessary invasive procedures, overtreatment, and misdiagnosis.”
Patients over the age of 50 will be advised to get a screening colonoscopy for colon cancer.
Finally, depending upon your sex life, STD (sexually transmitted disease) testing may be done.
While all of these possibilities may seem overwhelming, you are in the driver’s seat at your annual physical. If you want to refuse any part of what your physician recommends, you have that right, although you may be required to sign a document stating it was your decision to decline the testing.
Ask about cost. It’s also your right. If your physician’s office doesn’t know exactly what your insurer will cover at your annual physical, get on the phone with your insurance company or, better yet, sign in online and read your policy coverage yourself.