The Case for the Physical Medical Exam

A recent op-ed in the New York Times by Dr. Ezekiel Emanuel entitled "Skip Your Annual Physical" caught my eye last week. As the managing partner of a company that promotes concierge care via a comprehensive annual physical, I am aware of the school of thought that believes that an annual physical is unnecessary. The major premise in Dr. Emanuel's article is that the physical does not reduce mortality overall. I believe that it is the basis under which Medicare does not cover an annual physical after the Introductory Preventive Physical Examination (IPPE) when you enter the system.

But there is another important point to this debate. I know from working with hundreds of doctors and hundreds of thousands of patients that having a stronger doctor-patient relationship helps physicians to better understand and manage problems. More time together is what is needed to establish that kind of relationship, and often that time is only available during an annual check-up. The physical offers the opportunity to focus on two very important elements of care: the lifestyle decisions of the patient (nutrition, exercise, destructive behaviors, etc.) and trust. Even Dr. Emanuel acknowledges that "the exam provides an opportunity to talk and reaffirm the physician-patient relationship even if there is no specific complaint."  In other words, just hearing from your trusted physician that you are well offers peace-of-mind, which can be very good for one's health.

There can be more than just longevity as a measure of the effectiveness of the annual physical.  While an annual physical may not extend lifespan, it can improve quality of life, which may be more important to the patient. There is also a psychological component to the physical that can affect health in a positive way. Patients often feel better after spending some quality time with their trusted physician. That's important to note.

After careful consideration of Dr. Emanuel's position, I agree that for some people, an annual physical may not be necessary. However, for other people, it gives them an opportunity for greater insight into their care, and can address the emotional and psychological components of that care. Given that, it should remain something that a patient can choose to pursue if they wish. And they are pursuing it, often by joining concierge programs.

My company has seen very significant increases in membership in new concierge programs - even in the concierge programs of doctors we've worked with for years. With all the changes going on in healthcare today, patients are now recognizing the value of having a personal relationship with their physician and are increasingly willing to pay for it. Patients want to make their own decisions regarding their health management, including their annual physical examinations.

Dr. Emanuel's closing recommendation is that patients should skip their physical in order to give doctors more time to take care of those who need them, in an environment where there is a shortage of physicians. It should not be the responsibility of individual patients to help the medical system expand the availability of doctors by limiting their own care. Fortunately there are still some decisions that are made by physicians and their patients.