University of Pennsylvania bioethicist Dr. Ezekiel Emanuel struck again the other day with a recommendation that many Americans might see as a message from the Ivory Tower: Skip your annual physical because it's “worthless.” This after the healthcare reform law he played a role in crafting made such exams available to many Americans free of charge under their insurance.
Last fall, Emanuel got a lot of attention for his Atlantic Monthly essay titled “Why I Hope to Die at 75: An Argument That Society and Families—and You—Will be Better Off if Nature Takes its Course Swiftly And Promptly.”
I really don't want to spend too much of my time debunking the distinguished Dr. Emanuel, but I did not care for his latest op-ed piece any more than I liked his Atlantic essay.
While he makes good points in both pieces, frankly, they smack of condescension. He doesn't seem to respect that other people may have different values and a different sense of the risks and quality of life they're willing to accept.
In dismissing the value of the annual physical exam, Emanuel certainly has empirical support, citing the Cochrane Collaboration's review of 14 randomized controlled trials that found annual exams did not reduce mortality overall or deaths from cancer or heart disease, while costing a lot of money.
If you screen thousands of people, he writes, you'll find only a few who receive a diagnosis as a result of the annual physical, and even fewer who gain a health benefit from an early diagnosis, while healthy patients may be hurt by testing and treatment that wasn't necessary.
But neither patients nor physicians want to hear the message because annual physicals “reaffirm the physician-patient relationship” and because “almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story,” he writes. “Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial.”
Actually, there are practical reasons why such exams are necessary, at least for now. Many primary-care doctors, mine for instance, refuse to refill prescriptions for chronic conditions unless their patients come in at least once a year to see how the drugs are working and if there are any side effects. Without a regular personal exam, they could be held responsible if something went wrong. Besides, doctors want to get paid, and there generally is no insurance reimbursement under the current fee-for-service system for refilling prescriptions without an office visit.
But more importantly, people are not statistics, as conservative blogger Wesley Smith notes in a recent post. Smith cites several relatives, friends and neighbors who benefited from diagnoses made during annual checkups. His bitter summary of Emanuel's argument: “We owe it to others not to be among those supposed few” whose lives are saved.
Actually, I'm among those who “think they know someone” whose annual physical led to an important diagnosis. Many years ago, my wife went in for an annual checkup, and our wonderful Chicago internist at the time, Dr. Anna Wu, made an early diagnosis of a condition after reading her blood panel results and ordering further tests. That very likely did save my wife's life.
No, Dr. Emanuel, I will not join you in your resolution not to get an annual exam.
Follow Harris Meyer on Twitter: @MHHmeyer