SITTING in a cold, sterile room in a blue paper dress, you tell yourself you're taking care of business. That's when the doctor listens to your heart and lungs, hits the knees with a mallet, shines a flashlight into eyes, nose and mouth -- and pronounces you fit as a fiddle. Ready to go for another year.
Don't kid yourself. Study after study has found that the annual physical exam is almost worthless, a medical anachronism that should be buried alongside the iron lung and mercurochrome. Doctors admit they rarely detect anything by listening to the heart and lungs of a healthy adult, and when they do, the results are usually spurious. Ditto for blood work.
Even routine prostate and manual breast exams have been discounted as poor detectors of cancer, leading some experts to suggest, only half-jokingly, that there is hardly any reason for a healthy, symptom-free man or woman to ever again disrobe in a doctor's office.
Yet the routine annual physical will not go gently into that good night. Most primary care physicians continue to perform it, and a study published last June in the Archives of Internal Medicine found widespread resistance -- on the part of both patients and doctors -- to new guidelines that recommend more selective screening based on personal and family history.
"Most of us haven't had the guts to get rid of it," says Dr. Fred Heidrich, a physician at Group Health Cooperative in Seattle and clinical professor at the University of Washington.
Though this is not, as Heidrich adds, just a matter of guts. Many doctors and patients see something inherently valuable to these annual meet-and-greets, a benefit not easily measured by a study. The yearly physical is a chance to forge a bond, to talk about habits and mood and get a patient to make important lifestyle changes. It's a chance, in these days of rushed office visits, for patients to get some hard-to-come-by attention that makes them, quite simply, feel better.
Out of this debate, a more useful annual exam is taking shape. Instead of offering blood work and palpation to all comers, it provides something more pragmatic: discussion. About smoking, alcohol consumption, depression, eating habits, exercise, safe sex, even driving with seat belts.
The challenge, doctors say, is in shifting patients' expectations -- and convincing them that they're not just being shortchanged by a health plan's obsession with the bottom line.
A long tradition
