Routine Physicals, Routine Labs

I still sometimes get messages from patients without known chronic illnesses who want “routine blood work” and “routine physicals”. This terrible set of medical myths just won’t go away. It is even getting promoted by well-meaning but misinformed employee wellness programs.

In spite of all the talk about evidence based medicine, patients and colleagues all around me are clinging to the antiquated misperception that disproven rituals like digital rectal and testicular exams, clinical and self administered breast exams, annual lipid profiles, PSA tests, EKGs and 20-item chemistry profiles have anything to do with good health and longevity.

A dozen years ago I started offering instead an “Annual Health Review”, a brief opportunity to talk about each patient’s individual risk factors, based on family history, personal metrics and lifestyle. I also did a symptom inventory or review of systems. But I did not check their sodium or vitamin D levels, their back molars or the lint between their toes.

That sounds a little like the new Medicare Annual Wellness Visit, but that one rigidly demands that every patient gets screened for exactly the same items (risking non-payment if a single thing is missed). The AWV is cluttered by more or less mandated silly, medically unproven items like baseline EKGs and visual acuity by means of the Norman Rockwell style eye chart (seniors need their intraocular pressures measured; even the DMV checks their acuity, at no extra cost).

The canned Routine Physical, no longer recommended by the US Public Health Service Taskforce on Prevention, is a relic from a bygone era. These days, when people can send out for their own personalized genetic profiles, their family doctors are stubbornly treating everyone according to the same yardsticks and protocols.

This costly ritual consumes more than half of the working hours of some doctors: Thirty minutes per patient times the “ideal” panel size of 1,500-2,000 patients amounts to 750-1,000 hours of a normal 2,000 hour year. Consequently we see our patients go to walk-in care or, worse, the emergency room when they get a cut, a headache, bronchitis or the flu, so we can keep doing all those physicals.

2 Responses to “Routine Physicals, Routine Labs”

  1. 1 Aletha Cress Oglesby, M.D. December 26, 2017 at 2:23 pm

    I hope someone at CMS reads this post, country doctor. I’m going in for my Welcome to Medicare “physical” next year, and I already told my doctor, who is a friend, that it will be her easiest visit of the year, as everything it checks for I already know I don’t have a problem with. I work in an urgent care clinic and many of the people I see come there because there is a 3-6 week wait to see their primary care doctor-probably because they’re booked up doing physicals.

  2. 2 Dr.. Ramos December 26, 2017 at 5:43 pm

    good article.
    As long as we have guidelines we must follow to satisfy CMS lengthy checklists we will need to continue wasting time doing these wellness visits that can easily be completed by a medical assistant or a home health aide.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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