Annual health checks – do they make sense
Annual health checks (AHCs) are done when all is apparently well health-wise with you, meaning, when nothing has yet been perceived that there is something that is keeping you unwell. When something is unwell, then the entire focus is on the symptoms and all tests and examinations are focused around finding the reason for being unwell. This is not then a AHC.
AHC are a good thing to do and are done by individuals only if sponsored by the insurance or by companies in which they work. Seldom are they done by the population on their own or even on advice by their doctor.
More and more research done now claim that AHCs by itself do not improve quality of life or influence longevity.
At an individual level they might be a good thing to do, but statistically are not. To the general population they add little value for the costs involved.
America, for example, spends more per capita on health care than any other developed nation, yet Americans rank around 50 for life expectancy and hence are among the sickest citizens of the developed world.
Americans also rank near the bottom for everything from infant mortality to obesity, heart disease, and disability. Many studies attribute this to excessive medical intervention. And AHC can be seen as nothing but a type of excessive, and at time, unnecessary medical intervention.
Some studies have even suggested that AHC could do more harm than good due to investigations involved and catching up infections while getting these done.
According to Dr. Ateev Mehrotra, associate professor of healthcare policy and medicine at the Harvard Medical school, ‘This specialized visit hasn’t proven anything in terms of staying healthful.’
Dr. Mehrotra co-wrote an editorial in a recent edition of the New England Journal of Medicine calling the AHCs outdated and pointed out that physicals for healthy individuals can result in a battery of unnecessary tests and visits that aren’t effective in preventing disease.
Dr. Mehrotra further says that physicals ‘make sense in theory, but it hasn’t borne out in reality.’
According to Dr. Mehrotra, the annual physical should be reserved for a smaller subset of the population who stand to benefit the most.
Time magazine in its article noted that studies in which people have been randomly assigned to get an annual physical or not have found there is no significant difference in health between the two groups.
However, Dr. Allan Goroll, professor of Medicine at Harvard Medical School, in an editorial wrote in favor of the annual physical, saying ‘the problem is not the physical itself; it’s that doctors don’t have time to provide truly personalized care based on health history and individual circumstances’.
Dr. Goroll suggests this could be addressed by letting nurses and physician assistants handle testing involved in AHC thus freeing up primary doctors to focus on building relationships with patients, and providing individualized patient care.
What should be done annually to test detecting early a commonly prevailing disease, especially when the evidence is fairly clear that there is minimal benefit to annual exams involving a plethora of tests. As a general rule, most physicians would agree to do tests as below on an annual basis:
- Fasting blood sugar: Is desirable to be around 80 mg/dl. Risk of coronary heart disease (CHD) increases 3 times if 125mg/dl.
- Fasting lipid profile (cholesterol [HDL & LDL], triglycerides, etc.): Undesirable values and ratios are a risk to CHD.
- Blood Pressure: Is an important risk factor for CHD.
- Height-weight ratio (BMI) & Waist-hip ratio: Is a strong indicator for insulin sensitivity and risk for diabetes and CHD.
- Iron levels: Too little or too much iron can be dangerous. Excess iron, being a strong oxidative stress, is a risk for CHD.
- Vitamin D levels: Maintain levels around 50 ng/ml.
- Family-history related testing: If, for example, there is a family history of cancer, your doctor will advise appropriate tests.
- Age-related testing: Some tests like PSA, Mammograms, DEXA for bone density should be advised by your doctor.
Just doing AHC and doing nothing about it will not keep you healthy. Instead, making wise lifestyle choices as mentioned below will:
- Be physically active.
- Learn to manage stress.
- Eat plant-based diet.
- Have enough omega-3 fatty acids.
- Do not smoke.
- Keep Vitamin D levels around 50 ng/ml.
- Avoid processed foods.
- Avoid unnecessary drugs.
- Stay away from chemicals, toxins and pollutants.
- Be as much happy as you can.
Work-related health checks done based on work-type as mandated by local laws are beyond the scope of this discussion; they are mandated by laws prevailing in the country of your work (job) and should continue.
