Why you probably don't need an annual checkup this year

    There is suprising little evidence that routine checkups translate into better health for the average person

    Published: December 2013

    What could possibly be wrong with getting that annual exam?

    Well, a couple of things. First, research now suggests that head-to-toe annual checkups won't help the average person live longer or have fewer health problems. But they can trigger unnecessary follow-up tests and treatments, which are money- and time-wasters that can also pose health risks.

    In fact, a growing chorus of experts are questioning what has become, for many, a yearly ritual of blood tests, electrocardiograms, and chest X-rays. And the critics speaking the loudest are the doctors who have been doing all that prodding, poking, and peeking.

    They include those who belong to the American College of Phy­s­icians, the American Medical Association, and the Society of General Internal Medicine. That last group, in fact, recently included annual exams in a list of medical exams that are often done unnecessarily, as part of a campaign called Choosing Wisely, that aims to reduce wasteful and potentially harmful medical care. The campaign is led by Consumer Reports and the ABIM Foundation, a group formed by the American Board of Internal Medicine.

    "No one is saying preventive care is unnecessary," says Ateev Mehrotra, M.D., an associate professor of health care policy at the Harvard Medical School. "You just don't need the annual, one-size-fits-all physical."

    What is needed is a more targeted approach that varies based on your age, gender, and health, and that focuses on what really works. For example, women often think that they need annual Pap smears, but new guidelines say that they can wait three years if their results are normal, and that they can often stop screening altogether after age 65. And some tests, such as prostate-cancer screening for men with the PSA blood test, have fallen out of favor because research has found that the benefits don't outweigh the risks.

    See the screening tests you do need, and how often you need them.

    Unproven benefits

    Evidence against standard annual exams comes from the independent Cochrane Collaboration, which does comprehensive medical reviews. For its analysis of those exams, published in 2013, researchers looked at 14 well-designed studies involving a total of 182,880 people. In each study, some people were offered annual exams and some weren't. Researchers found no difference in the number of overall deaths or deaths from cancer or heart disease. Annual physicals also didn't reduce hospital admissions, disability, doctor visits, or time off from work.

    Possible risks

    But the Cochrane review did suggest that annual exams might lead to health problems. For example, those who had checkups had higher rates of new diagnoses, including many that might never have caused symptoms or shortened lives but might have been treated with drugs or other interventions.

    And therein lies the problem. Why? Because for people without symptoms, the string of tests ordered during annual checkups can produce false alarms. That's true for everything from urine and blood tests to electrocardiograms. EKGs, for example, aren't very revealing for people who aren't at high risk of heart disease or for those who don't have symptoms of it.  

    So a false alarm or a misreading of an EKG could provoke anxiety and trigger follow-up heart tests, some of which can expose you to radiation and others that can trigger a heart attack in up to 2 percent of people. (Read more about diagnosing heart disease.) In some cases misleading test results can lead to inappropriate treatment, including invasive procedures like angioplasty. (Read more about angioplasty and treating heart disease.)

    A new approach

    For those in good health, this new way of getting preventive care means that you don't need to do everything all in one appointment, year after year. For example, you can get your weight and blood pressure checked or talk about weight loss, your emotional health, or smoking cessation almost whenever you see a physician.

    And some services can be provided without going to the doctor. If you're due for a cholesterol test or a mammogram, for example, your doctor can send you to a lab or imaging facility without seeing you first. The key: Talk with him or her about what's right for you, then make sure you get the tests and follow-up care you need.  

    Read our advice on the screening test you do need, and when you need them.

    Should you get dental exams twice a year?

    Probably not. A recent study that followed 5,117 adults for 16 years found that most people who saw a dentist just once a year were no more likely to have tooth loss than those who went for the standard twice-a-year visit. The exception: people at high risk for gum disease because they smoke, have diabetes, or are genetically prone to inflammatory diseases.

    Editor's Note:

    This article first appeared in the January 2014 issue of Consumer Reports on Health.

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