Annual checkups do not result in better health outcomes, national task force reaffirms

Annual checkups do not result in better health outcomes, national task force reaffirms

The Canadian Task Force on Preventive Health Care affirms earlier findings that routine annual checkups do not offer sufficient health benefits to justify the expense or effort

 Montreal, November 14, 2017 – As far back as 1978, the Canadian Task Force on the Periodic Health Examination recommended abandoning the tradition of the annual physical exam and adopting an age-specific health protection approach that emphasized the identification and early management of potentially preventable conditions. Despite this, non-specific annual checkups continue to be a part of health care for many Canadians. Now, in an article published in Canadian Family Physician, the Canadian Task Force on Preventive Health Care, has again called for the end of the annual checkup and replacing it with focused age-appropriate health prevention activities. This conclusion was based on evidence that patients who have annual checkups do not achieve better health outcomes than those who do not. The Task Force expressed concern that annual non-specific checkups can also lead to over-diagnosis and the revelation of conditions of uncertain clinical importance, which can lead to anxiety and unnecessary medical intervention.

“A long-standing argument has been that annual, non-specific doctor-patient encounters will lead to better health outcomes, but the evidence simply doesn’t support it,” says Dr. Brett Thombs, who chairs the Task Force. Dr. Thombs is a senior investigator with the Lady Davis Institute at the Jewish General Hospital and a Professor in the Faculty of Medicine at McGill University. “However, there is value in periodic visits to primary care physicians for specific prevention activities. Women around 50 years of age should visit their doctor to discuss possible benefits and harms and to make a decision about whether to undergo mammography screening for breast cancer or men over 65 years of age should discuss screening for abdominal aortic aneurysm, for instance.”

Dr. Thombs emphasizes that Canadians should be able to easily access their primary care doctor when they are ill, for age-appropriate prevention activities, or for managing a chronic condition. However, unnecessary visits to the doctor for annual checkups make this difficult for many Canadians who do not have regular access to a family doctor, notes Dr. Thombs.

“We have known for many years that having an annual physical checkup has very little benefit to well individuals and may have some harms,” says Dr. Richard Birtwhistle, Professor of Family Medicine and Public Health Sciences at Queen’s University, and first author on the paper. “We want to change the conversation to focus on the delivery of preventive services through periodic preventive health visits and those things that we know may benefit an individual’s health.”

Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart and effective health care choices that take into consideration a patient’s individual care needs. Choosing Wisely Canada, The College of Family Physicians of Canada, and The Nurse Practitioner Association of Canada have a recommendation that states ‘Don’t do annual physical exams on asymptomatic adults with no significant risk factors.’ Dr. Kimberly Wintemute, one of two family medicine leads for Choosing Wisely Canada adds, “Seeing your family doctor for targeted preventive screening and lifestyle counseling is important, but examining all body systems and doing a battery of tests does not improve overall health. Preventive care should be personalized and should involve shared decision-making between you and your doctor.”

The position paper from the Task Force, “Periodic preventive health visits: A more appropriate approach to delivering preventive services,” can be found in the November issue of Canadian Family Physician.