February 15, 2011 - Preventive care is more important than an annual physical, according to both an Archives of Internal Medicine article and the president of the American Academy of Family Physicians. Preventive care is incorporated into an annual exam only about 20% of the time with the remaining 80% of prevention occurring during other office visits or venues.
About 21% of Americans (44.4 million people) and 18% of women (19.4 million women) receive an annual preventive exam. These visits account for one in twelve office visits annually in the United States. The cost for these exams totals about 7.8 billion dollars. To frame the cost in comparison to other healthcare expenditures, the total spent on all breast cancer treatments in 2004 was 8.1 billion.
"Although annual exams are not recommended by any major North American clinical organization, our [national] health system is clearly devoting a great deal of time, money, and resources to them," noted Ateev Mehrotra, MD, lead author of the Archives of Internal Medicine article, assistant professor at the University of Pittsburgh School of Medicine, and a policy analyst at RAND Corp. "Most patients believe they should see a doctor every year for a physical in which the doctor will examine them from head to toe and order lots of tests. There are many doctors who disagree. Physicians need to reach greater consensus on what we should advise patients to do," he adds.
An excellent resource for patients, families, physicians and mid-level providers (nurse practitioners and physician assistants) is the National Guideline Clearinghouse sponsored by the U. S. Department of Health and Human Services (http://www.guideline.gov/index.aspx).
Starting this year, Medicare will cover two types of physical exams—one when you are new to Medicare and one yearly thereafter. If you are new to Medicare Part B you are entitled to an exam which will review your health, focus on prevention, and suggest further consultation and/or education if indicated.
After a year on Medicare an individual is entitled to a wellness visit to develop or update a prevention plan. Assuming the patient is healthy, this plan can include a one-time screening for abdominal aortic aneurysms, bone mass measurement, cardiovascular screenings including a cholesterol check every five years, colon cancer screening every decade, diabetes screening, diabetes education if appropriate, flu shots, pneumonia shots periodically, glaucoma tests, Hepatitis B inoculations, HIV screening, mammograms, pelvic exams, prostate cancer screening and smoking cessation (up to eight face to face counseling sessions in a year).
For non-Medicare patients the following topics are labeled “must be covered” at every opportunity because they have been proven to make a difference: aspirin chemoprophylaxis counseling, breast cancer screening, calcium chemoprophylaxis counseling, cervical cancer screening, chlamydia screening, colorectal cancer screening, hypertension assesment, influenza immunization, lipid analysis, pneumococcal immunization, problem drinking screening and brief counseling, tobacco use screening and brief intervention, and vision screening. Chemoprophylaxis is using a medicine to prevent future illnesses. Most of these are age specific and some are gender specific.
Anyone who already has a health problem or family history of specific diseases needs to focus on these areas of concern with their physician or mid-level provider. Clearly, individual good health is best addressed by prevention – or at least early detection.
Community health is the aggregate of all of our individual well-being. These two goals, community health and individual well being are congruent and synergistic. As we all attack public health problems such as smoking, obesity, heart disease, cancer, sexually transmitted diseases and other common but unnecessary afflictions, we will improve our lives, our community and our nation. Focusing on prevention during the annual physical exam helps to accomplish these noble goals.