Should We Abandon Routine Visits? There Is Little Evidence for or Against
Authors: David U. Himmelstein, Russell S. Phillips
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions5 April 2016Should We Abandon Routine Visits? There Is Little Evidence for or AgainstDavid U. Himmelstein, MD and Russell S. Phillips, MDDavid U. Himmelstein, MDFrom City University of New York School of Public Health at Hunter College, New York, New York, and Center for Primary Care, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.Search for more papers by this author and Russell S. Phillips, MDFrom City University of New York School of Public Health at Hunter College, New York, New York, and Center for Primary Care, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2097 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A revolt is brewing against the tradition of periodic visits for patients without specific health concerns. A prominent colleague urged patients to “skip your annual physical” and “free up countless hours of doctors' time” (1). Even the Society for General Internal Medicine advised primary care physicians to avoid “routine general health checks for asymptomatic adults” (2).Much of the evidentiary support for such recommendations comes from a Cochrane review that concluded that general health checks for adults “did not reduce morbidity or mortality” (3). However, we, like many colleagues, view the routine (although not necessarily annual) well-patient visit as a ...References1. Emanuel EJ. Skip your annual physical. The New York Times. 8 January 2015. Accessed at www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html on 29 April 2015. Google Scholar2. Sussman J, Beyth RJ. Choosing Wisely: Five Things Physicians and Patients Should Question: Don't perform routine general health checks for asymptomatic adults. Alexandria, VA: Society of General Internal Medicine; 2013. Accessed at www.sgim.org/File%20Library/JGIM/Web%20Only/Choosing%20Wisely/General-Health-Checks.pdf on 24 November 2013. Google Scholar3. Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345:e7191. [PMID: 23169868] doi:10.1136/bmj.e7191 CrossrefMedlineGoogle Scholar4. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457-502. [PMID: 16202000] CrossrefMedlineGoogle Scholar5. The South-East London Screening Study Group. A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. Int J Epidemiol. 1977;6:357-63. [PMID: 608798] CrossrefMedlineGoogle Scholar6. Lannerstad O, Sternby NH, Isacsson SO, Lindgren G, Lindell SE. Effects of a health screening on mortality and causes of death in middle-aged men. A prospective study from 1970 to 1974 of men in Malmö, born 1914. Scand J Soc Med. 1977;5:137-40. [PMID: 594708] CrossrefMedlineGoogle Scholar7. Dales LG, Friedman GD, Ramcharan S, Siegelaub AB, Campbell BA, Feldman R, et al. Multiphasic checkup evaluation study. 3. Outpatient clinic utilization, hospitalization, and mortality experience after seven years. Prev Med. 1973;2:221-35. [PMID: 4723638] CrossrefMedlineGoogle Scholar8. Friedman GD, Collen MF, Fireman BH. Multiphasic Health Checkup Evaluation: a 16-year follow-up. J Chronic Dis. 1986;39:453-63. [PMID: 3711252] CrossrefMedlineGoogle Scholar9. Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med. 2007;146:289-300. [PMID: 17310053]. doi:10.7326/0003-4819-146-4-200702200-00008 LinkGoogle Scholar10. Shapiro S. Evaluation of two contrasting types of screening programs. Prev Med. 1973;2:266-77. [PMID: 4579345] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From City University of New York School of Public Health at Hunter College, New York, New York, and Center for Primary Care, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2097.Corresponding Author: David U. Himmelstein, MD, City University of New York School of Public Health at Hunter College, 255 West 90th Street, 12A, New York, NY 10024; e-mail, [email protected]cuny.edu.Current Author Addresses: Dr. Himmelstein: City University of New York School of Public Health at Hunter College, 255 West 90th Street, 12A, New York, NY 10024.Dr. Phillips: William Applebaum Professor of Medicine, Harvard Medical School, Center for Primary Care, 635 Huntington Avenue, Boston, MA 02115.Author Contributions: Conception and design: D.U. Himmelstein.Analysis and interpretation of the data: D.U. Himmelstein, R.S. Phillips.Drafting of the article: D.U. Himmelstein, R.S. Phillips.Critical revision of the article for important intellectual content: R.S. Phillips.Final approval of the article: D.U. Himmelstein, R.S. Phillips.Collection and assembly of data: D.U. Himmelstein.This article was published online first at www.annals.org on 5 January 2016. 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Gluckman, MD 5 April 2016Volume 164, Issue 7Page: 498-499KeywordsElderlyHealth insuranceHealth screeningMortalityPatientsPrevention, policy, and public healthPrimary care physiciansSystematic reviewsUrineVisual acuity ePublished: 5 January 2016 Issue Published: 5 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...