RENEE MONTAGNE, HOST:
Today in Your Health, two questions about when one should seek medical care. In a moment - why many women don't seek help during a heart attack. First, a medical ritual for millions of Americans - the annual physical, yearly prodding and poking with questions about exercise and alcohol intake. There is little evidence to show these checkups do any good for healthy adults, and they may be worth skipping altogether, as Jenny Gold reports.
JENNY GOLD, BYLINE: It's a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care for a physical exam. He's a handsome and strapping guy with a thick, black beard and square glasses. Dr. Mark Caruso shakes his hand with a welcoming smile.
MARK CARUSO: Mr. Vega, I'm Dr. Caruso, a pleasure to meet you.
EMANUEL VEGA: Very nice to meet you.
CARUSO: And when was your last full diagnostic?
VEGA: Wow, I don't even remember - probably 12-13 years ago.
GOLD: He says he didn't really feel like he needed to come in.
VEGA: I am feeling good. I don't do drugs. I don't drink. My wife went ahead and made the appointment, and I was all about it.
GOLD: Especially because it's free under his insurance policy - not even a copay. Dr. Caruso starts with the basics.
CARUSO: Open please. Say ah.
GOLD: He listens to Vega's heart and lungs, checks the pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise routine - impressive - his rest schedule could use some work - and orders blood and urine tests. As long as everything checks out all right, they'll do it all again next year.
CARUSO: We'll ask one year - allow us to do this full diagnostic.
VEGA: Yeah, yeah, sure, of course
GOLD: Vega says he'll definitely be back. More than 44 million Americans get a physical exam each year, but as it turns out, the evidence is not on their side, says Dr. Ateev Mehrotra, a professor of health policy at Harvard Medical School.
ATEEV MEHROTRA: I would argue that we should move forward with the elimination of the annual physical.
GOLD: Mehrotra is also a primary care doctor. He says patients should really only go to the doctor if something is wrong or if it's time for them to have an important test, like a colonoscopy.
MEHROTRA: When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm, you know, attacking moms and apple pie here. It's - you know, it seems so intuitive and so straightforward and something that's been part of medicine for such a long time.
GOLD: But he says randomized trials going all the way back to the 1980s just don't support it.
MEHROTRA: They don't really help patients.
GOLD: The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid completely for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs just $150, but with so many people coming in every year, that adds up fast.
MEHROTRA: We estimate that it's about $10 billion a year, which is more than how much we spend as a society on breast cancer care. It's a lot of money.
GOLD: And then there's the risk that a doctor will run a test and find a problem that's not actually there. It's called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. Dr. Michael Rothberg is a health researcher at the Cleveland Clinic. He says, as a doctor, he generally avoids giving physicals.
MICHAEL ROTHBERG: I generally don't like to frighten people. And I, you know, mostly tell my family if they're feeling well to stay away from doctors because, you know, if you get near them then they're going to start to look for things and order tests 'cause that's what doctors do.
GOLD: Back in Miami, Dr. Caruso is also well-versed in the research on annual physicals, but he still believes in them.
CARUSO: I think having a look at somebody is worth its weight in gold.
GOLD: He says it's an important part of developing a relationship with a patient. And there have been countless times when he's found real problems during an exam, just like the one he gave to Emanuel Vega.
CARUSO: What if Mr. Vega had had a lump or bump that wasn't right? What if when he had his shirt off Mr. Vega said oh, yeah, I forgot to mention this spot on my chest and it ended being a melanoma that we discover early?
GOLD: The federal government seems to agree. The Affordable Care Act requires all insurance plans to cover annual physicals at zero cost to patients. For NPR News, I'm Jenny Gold.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.