Is the annual medical check really useful?

annual tailored health check
Do most of us need to go to the doctor every year for a medical examination? You may find this problem silly, especially if it comes from my family doctor who often discusses preventive medicine in the article. I am happy to see my old patients coming back every year, give them another check to make sure they have a healthy lifestyle and provide "adjustment advice" from a medical perspective. Most of my colleagues and patients feel that an annual physical examination is helpful. But there is growing evidence that most of the doctors in the annual inspections do not necessarily help most people, and may not make us live longer and better. In fact, a 2012 Cochrane meta-analysis examined more than 180,000 people who followed their physical examination for about 10 years and found no significant reduction in their mortality, cancer or heart disease incidence. The Society of General Internal Medicine solemnly reminds doctors to "do not perform routine general medical examinations for asymptomatic adults... regular medical examinations scheduled for no special reason, including annual inspections including 'health care', Reducing morbidity, mortality, or hospitalization rates has shown no effect, but unnecessary inspections have caused potential harm."

Since there is no supporting evidence, why do we, especially some of the Chinese people I contact, still regard the annual medical examination as a major event to ensure health and safety? Many Chinese seem to be very enthusiastic about the annual medical check-up package. I think most of them believe that the more inspections they do, the better they can understand their personal health. In those famous private stereo inspection centres, I also had three medical examinations. Although their efficiency is surprising, what makes me uneasy is that a large number of checks I do are unfounded. I felt like I was rushed into the slaughterhouse, moving on an assembly line, and the embarrassing parts were poked and stabbed. But the people around me seem to be happy and at ease because they are conducting a "responsible for health" check.
Sir William Osler, MD
In addition to discovering that some tests are meaningless, I still have a big question: no doctor has sat down to talk to me, ask me what are the underlying causes, understand my lifestyle and family history, and then decide which ones to do. Detection. No matter how much you spend, there is no physical examination package that is better than an excellent first-time doctor who knows you and only asks you a few questions. Every good doctor gets 80-90% of the diagnosis through the patient's medical history and physical examination. William Osler, the father of modern medicine, famously said: "Listen to your patients seriously, he is talking about the diagnosis."

If our doctor must arrange for a test to determine the presence of a condition, strong evidence should be obtained from different studies to prove that the test is accurate and sensitive, that no real illness will be missed and that it will not be misdiagnosed. It should also be cost-effective and suitable for batch testing. A good screening test should also be able to identify diseases that are easy to cure and treat. Many screening tests are really effective, saving many people's lives, such as blood pressure, glucose determination, and rectal cancer screening for all people over the age of 50. Multiple studies provide strong evidence that those tests can save many lives.

But there are also a lot of other tests that have no strong evidence. In the case of cancer screening, not all examinations are meaningful: there is ample evidence that Pap smear, mammography, and colonoscopy are especially helpful for people of special age; but other cancers Screening tests, including chest X-rays and prostate-specific antigen testing, especially for blood sampling of tumour markers, are almost ineffective. Compared with my native United States, many Chinese patients I have come across seem to be more concerned with performing as many blood tests as possible on tumor markers during physical examinations, but these tests are rarely as accurate or useful as screening tests. The American Cancer Society has written a good review of these tumor markers, saying that "tumor markers are mainly used in patients who have been diagnosed with cancer to observe their response to treatment or to see treatment. After the recurrence symptoms, however, most Chinese patients who completed the physical examination came out and showed me their tumor examination report, which contained a series of "normal" indicators, but they did not seem to know most of these tests. accurate. They feel that they don't have cancer, they are relieved, but this is not true. From these tests, it is not possible to accurately determine whether or not they are sick. I hope that such testing will become more accurate in a few years, but most of the current is not the case.

Of course, there are many times when a test result is abnormal, and the follow-up may actually find some dangerous but curable conditions, thus saving the patient's life. However, there are also a large proportion of abnormal results in tumor markers, computed tomography (CT) X-rays, and other screening tests. A benign mass such as an unexpected tumor is found, which scares the patient to be expensive and invasive. The exploratory experiment did not reveal any serious problems. Similarly, screening tests themselves can also cause problems – if a young woman does a CT scan every year to rule out cancer, this approach not only eliminates cancer by routine testing, but also because of the strong CT radiation during the annual exam. Greatly increased her risk of cancer.

Excessive testing of patients with potentially dangerous screening tests is actually a big problem and has caused billions of dollars in waste worldwide. In the United States, many of the most prestigious medical societies have made an annual list called Choosing Wisely, which lists general checks that should be done as little as possible. For example, my American Academy of Family Practice recommends that you do not have a regular electrocardiogram (ECG) exam on annual health checkups for all healthy people; do not do bone mineral density (DEXA) in healthy women under 65 years of age. Scan; women under the age of 21 do not have a Pap smear.

So how do patients make the best choice? If possible, don't choose a prescribed medical check-up package. The best way is to do a tailor-made physical exam. At the beginning, the patient and the doctor should sit down together, review their medical history and conduct a physical examination. After completing these critical first steps, the doctor decides which of the appropriate tests should be done. Compared to a 35-year-old man who has a big belly, smokes from the age of 12 and sleeps less than 6 hours a day, the same age-slim, thin-skinned man needs much less screening tests. In fact, the former benefited more from the doctor's advice than the examination. I also know that public hospitals in China are overcrowded and it is difficult for patients to have long interviews with doctors. However, many general hospitals now have general outpatient clinics, which are more suitable for you and your family than crowded and busy specialists. Health consultation, initial diagnosis and medical examination services.

I hope this article has not made me unemployed! Of course I am very happy to see my patients again, and I will continue to welcome them. I just hope that more of them no longer feel the need to buy a luxury medical check-up package. After reading this article, I hope they can understand that the first thing they should do is to see the newly diagnosed doctor. It is best to have the same doctor every year. We have to talk first, understand each other, see how your body is in a year, and then do a test. Then we decide what checks you need to do (if you need to check). I hope that when you leave my clinic, you will not only feel healthier, but also be more convinced that communication is more effective than a medical package. Always remember what Dr. Osler said: "Listen to your patients seriously, he is talking about the diagnosis."

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