New Thinking About the Annual Health Exam

Roberta Heale Associate Editor, @robertaheale @EBNursingBMJ

When I became a nurse practitioner in family practice twenty years ago, the annual health exam for every patient was standard care.  I remember thinking that it seemed to be unnecessary to examine healthy people without any symptoms or risk factors.  Research has shown this to be true and practice is changing.

A recent commentary in EBN about the effectiveness of general health checks shows that there is very little effect on reducing the morbidity and mortality of patients with no symptoms or risk factors https://ebn.bmj.com/content/early/2019/06/01/ebnurs-2019-103094 and https://www.cochrane.org/CD009009/EPOC_general-health-checks-reducing-illness-and-mortality

This, and other similar research has resulted in changes in family practice. Gone are the annual health checks for patients who are healthy, low risk and have no symptoms of illness.  Of course, people who have risk factors for certain cancers, cardiovascular disease etc. are still routinely checked. Also, appointments for pregnancy, well baby care, family planning, medication renewal, chronic disease management and more are still provided.  https://choosingwiselycanada.org/health-check-ups/

I see some important benefits in this change, namely the focus on preventative care. For example, some of my patients in the past felt reassured of their health when I didn’t find anything during an annual health exam, and continued with their unhealthy behaviour.  Now, I can stress with patients that behaviours such as smoking cigarettes sharply elevates their risk of developing lung cancer or cardiac disease regardless of whether they are currently asymptomatic.

Evidence should directly support clinical practice in positive changes toward patient care. Removal of the routine annual health exam not only matches the best evidence to date, it also moves the focus to preventative care. Definitely a win-win in my mind!

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