A new suggested lifetime health checkup schedule--based on a five-year time sequence for adults 20 to 65--was unveiled Monday by the American Heart Assn., substantially contradicting the traditional notion of the annual physical examination.
The new heart-association plan is part of a broader movement away from the annual checkup not unlike the trend toward longer maintenance intervals for the family car. Some doctors warn, however, that increasing the gaps between checkups may mean some serious illnesses go undetected.
The idea of a yearly checkup was introduced by the American Medical Assn. as early as 1923, but is currently under significant international revisionist pressure.
Annual Physical Losing Favor
In fact, the annual physical has been steadily losing favor for the last decade, giving way to what might be called the super-checkup.
The heart association, according to the organization's statement at a Dallas press conference Monday, "takes the position that prevention is the greatest need in cardiovascular medicine. Prevention, however, demands an aggressive approach and the involvement of both the general public and the medical profession.
"The physician . . . should be concerned with the whole person, and a full evaluation of an individual's overall health needs to be incorporated into any plan for periodic examinations."
The proposal is being introduced amid a rapidly developing movement in the U.S. and Canada to substantially revise the timing and nature of preventive health screenings. Government-sponsored commissions from both countries are planning a joint meeting later this year to discuss a unified international strategy to speed change.
The Canadian Task Force on the Periodic Health Examination has already produced a series of comprehensive proposals for reform, though commission officials say doctors have been slow to adopt them. The U.S. Preventive Services Task Force expects to publish a series of medical-journal articles calling for specific reforms this year and follow up with a book-length work early in 1988.
The basis for checkup reform is that, for most adults in apparently normal health, blood and other laboratory tests performed on an annual basis are pointless and waste health-care resources.
The annual physical also has been widely criticized for being an empty, rote exercise for physicians in which there has been little agreement on what information should be obtained. What is needed, reformers contend, is a new sense of the checkup as a periodic interaction aimed at finding previously hidden disease and intervening--aggressively and effectively--in unhealthy life styles.
The annual checkup has also suffered because some physicians are uncertain about what kinds of habits they should inquire about--with sexual disorders, smoking behavior and weight-loss issues often being ignored.
While the proposals differ as to the timing of these new physicals--which are intended to utilize the latest diagnostic tests and equipment and rely on more comprehensive sets of questions to be asked by doctors--most proposals share these common elements:
- They increase the time between physicals, the most common interval being five years for healthy adults 20 to 60 or 65. The gaps narrow to a physical every 2 1/2 years between 65 and 75 and annually after that. Examinations for pregnant women and young children remain much more frequent. Nor does the new schedule apply to people known to have chronic diseases like diabetes, cancer or heart problems.
- The new physicals are supposed to emphasize more comprehensive laboratory work, with a variety of blood tests routinely performed and often quickly analyzed by increasingly common in-office testing equipment. The new generation of machines includes those that determine levels of fat in the blood within 10 minutes after a tiny sample of blood is taken from a pinprick in the finger.
- Some procedures traditionally performed during the annual checkup--such as the chest X-ray and the conventional electrocardiogram--are to be done much less often. But others, such as a procedure using a fiber-optic viewing device to explore the colon for evidence of cancer, are to be more routine at certain intervals--especially for older patients.
- Doctors are encouraged to ask more comprehensive questions and follow up more aggressively on their discussions of such habits as smoking. They also are urged to help patients plan life-style modifications to reduce cholesterol levels, weight and blood pressure.
The American Heart Assn. proposals for a new timetable for checkups--the first of their type ever made by the organization--emerge in the midst of this mounting pressure for change. The association's plan was formulated by a seven-member committee headed by Dr. Scott Grundy, director of the Center for Human Nutrition at the University of Texas Health Science Center in Dallas.