Annual physicals for healthy adults, and tests that are bad for you

Some studies and experts say that getting a standard physical as frequently as once a year is, on average, bad for healthy adults. The New York Times writes:

Some experts note that when something seemingly abnormal is picked up during a routine exam, the result is psychological distress for the patient, further testing that may do more harm than good, and increased medical expenses.

It’s not the physical that is harmful. Incorrect reactions to new information are harmful. This isn’t a good reason for a well-informed and critical patient to skip an exam: If the doctor finds something wrong with me and recommends a test or procedure, I can read up on my options and then decide what to do. If you’re acting optimally, more information can’t make you worse off.* But perhaps almost everyone overreacts to health information, and I am just as bad as the average person. Perhaps, if some test were to come up positive, I would be better off not knowing about it. But I’m skeptical.

I don’t think a physical will hurt me. Will it help? This study reviews randomized trials that gave routine physical exams to healthy adults and finds that they don’t seem to help survival, illness, or hospitalization rates. The standard errors are large enough and the variables are important enough that I still want more information.

The NIH recommends that healthy women aged 18-39 get a physical for the following reasons:

  • Blood pressure, cholesterol, and diabetes screening.

I’ve had my blood pressure checked, and given my diet and general good health I think it’s extremely unlikely that I have cholesterol or diabetes problems. Besides, the CVS Minute Clinic can check for those things without an appointment (except in Massachusetts).

  • Dental exam

I went to the dentist this year, since I was concerned about my wisdom teeth.

  • Immunizations

I have these. In addition, if my doctor recommends an immunization, I will need to make a few insurance-related phone calls before getting the immunization, so it won’t happen on the same visit anyway. So for me, there’s no point bundling these into the standard physical.

  • Height, weight, and BMI

You can easily check your height and weight at the gym. If they are unhealthy a doctor may help you with a diet an exercise plan, or she may just frown at you and tell you to lose weight. Anyway, my height and weight are healthy and are the same as they have been.

  • Your doctor or nurse may ask you about depression, diet and exercise, alcohol and tobacco use, and safety such as seat belts and smoke detectors.”

Thanks to the NIH, I just considered all of these things and confirmed that I am okay.

  • Complete breast exam every three years
  • Pelvic exam and Pap smear every two years for women over 21.

I can’t reliably detect breast cancer or cervical cancer on my own. This seems worthwhile.

* In game theory, if you have more information and other people know you have more information, you may be worse off.

About adaldrida

I'm a grad student. My interests are diffuse. Recently, I've spent a lot of time thinking about Empirical Bayes, psychiatry, and sports physiology.
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One Response to Annual physicals for healthy adults, and tests that are bad for you

  1. sunwei says:

    I think empiriacally the fraction of people who do not understand Simpson’s Paradox is huge, and they fail to understand that even with positive test result the probability that they are indeed ill is very tiny simply because the base rate is low. We might pride ourselves on understanding probability, but the ability to reason rationally probably won’t help us control worry emotionally. I once had a positive test for Tb, and though I knew about all the theory, my emotion system found the maths to be utterly unconvincing and I was distressed for a while until it is confirmed otherwise.

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