Chicago - Current practice guidelines that recommend against routine annual physicals for adults without specific symptoms of illness may not be widely accepted by primary care physicians, according to a study in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Current evidence-based guidelines, developed in the last 20 years, do not recommend a routine annual physical examination and testing for asymptomatic adults, suggesting instead more selective screening based on the patient's personal and family history and overall risk assessment, according to background information in the article. Despite these guidelines, the authors report, a high percentage of the general public desires an annual physical examination and extensive testing. The current attitudes of primary care physicians toward annual physical examinations have not been previously assessed.
Allan V. Prochazka, M.D., M.Sc., of the Denver Veterans Affairs Medical Center, and colleagues conducted a survey of the attitudes and practices regarding annual physical examinations of a random sample of primary care physicians (PCPs) including physicians specializing in internal medicine, family practice and obstetrics/gynecology who were located in the metropolitan areas of Boston, Denver and San Diego.
Of the 783 primary care physicians responding to the survey 65 percent believed an annual physical examination is necessary in addition to seeing patients for acute medical conditions and chronic medical illnesses. ".most (94 percent) believed that an annual physical examination improved the physician-patient relationship and provided valuable time for counseling on preventive health behaviors. Nearly all physicians (88 percent) indicated that they performed annual physical examinations. Seventy-eight percent believed that such an examination was expected by most patients," the researchers report.
"Surprisingly, in view of the current evidence, 74 percent thought that an annual physical examination improved the detection of subclinical illness [illness without symptoms]," the authors report. "Sixty-six percent believed that annual physical examinations are covered by insurance, 63 percent thought they were of proven value, and 55 percent disagreed with the statement that such examinations were not recommended by national organizations."
"It is clear that, despite national organizations no longer recommending annual examinations and lack of evidence supporting routine laboratory testing in asymptomatic individuals, the public desires such examinations and PCPs continue to believe in the value of these examinations," the authors write. "However, the PCPs in this study are very much in favor of the annual physical examination. Thus, there is a lack of concordance between the guidelines and those who would implement the guidelines. This is a critical challenge for achieving national prevention goals, because many of those on the front lines of primary care do not appear to accept the targeted recommendations of the guidelines."
(Arch Intern Med. 2005; 165:1347-1352.)
