Do no harm? Wisdom of annual checkups questioned by Calgary doctor
Overdoing a good thing can cause more harm than good, U of C prof says of fresh research
For most healthy Canadians, seeing your family doctor once a year for a checkup is not only unnecessary, in some cases it could cause harm, new research suggests.
"The problem is overdoing a good thing," Dr. James A. Dickinson told Alberta@Noon on Tuesday.
"Yes, periodic health assessments, maybe every three to five years have value, there are very specific things that we can do for people that really are worthwhile. But doing them every year has dangers that we may overdo things and thereby cause harm. It's all a matter of balance."
Dickinson is a family medicine professor at the University of Calgary and a co-author of fresh research on the value of annual medical checkups titled Periodic preventive health visits: a more appropriate approach to delivering preventive services.
'We find positives that aren't true positives'
He says the problem is doctors are hardwired to look for something and then treat it.
"If we do scans and other tests, very often we find positives that aren't true positives. Electrocardiograms on people who are perfectly healthy, we find minor abnormalities and then follow through," Dickinson explains.
"We can over-diagnose thyroid cancer. Three-quarters of all thyroid cancer in Canada actually isn't really a cancer that is going to kill somebody. That's a problem. We are over-treating people."
Dickinson says periodic visits for people without specific symptoms could be appropriate depending on the age of the patient.
"The annual physical is very much a North American phenomenon. Most other parts of the world don't do it. They actually do better in terms of their total health than we do in North America and it may be because when we over-treat things, we cause harm."
Best use of our time?
An Edmonton doctor and associate professor at the University of Alberta says other research shows a variety of downsides to yearly checkups, for most people without symptoms.
"Is this really the best use of our time, when we have patients who can't get in?" Dr. Tina Korownyk asks.
"There's lot of data to suggest at least one out of every five emergency visits is because the patient couldn't get in to see their primary care physician."
Korownyk recommends an honest conversation between the patient and doctor.
"Everyone should sit down with their primary care provider and say: 'This is who I am, this is my family history, this is my own personal history. What do you recommend would be the next interval I should follow up?'"
Another Calgary doctor, Dr. Ted Jablonski, says annual visits can be completely appropriate for some people and some situations.
"I tend to sit in the middle ground," Jablonski said.
"I think there are patients who benefit greatly from an annual review. If you don't want to call that a complete medical, I think that's fair. I think an annual review of looking at their medical problems, doing appropriate screening, getting that all done sometimes can be done very efficiently in an annual exam."
Jablonski says patient age should also be a factor in deciding frequency.
"After age 50 there are screening protocols which should come into place. That could be mammograms for females, potentially looking at blood pressure, lipids, screening for diabetes in men. These things should come to pass. On that kind of annual review, you are ensuring whatever screening is appropriate for that patient gets done."
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With files from Alberta@Noon