Is there value in detecting disease that has no symptoms in adults?
For decades the periodic health examination has been a mainstay in adult medical care. It consists of an updated medical history, physical examination and baseline lab studies, which may include a complete blood count, urinalysis and selected chemistries based on a patient’s age and risk factors for illness. Intervals for the examination may range from two or three years for healthy, young adults to annually for older or more illness-prone persons.
Clif CleavelandThe value of this tradition is currently questioned from several quarters. A complex analysis in 2012 of multiple clinical studies concluded that periodic health exams did not reduce total mortality or mortality related to specific diseases such as cancer or heart disease. In 2013, the Choosing Wisely campaign, sponsored by two internal medicine organizations, recommended that physicians drop the annual exam of asymptomatic adults because of high cost and low return.
In contrast, the Affordable Care Act and Medicare consider the exam as preventive care that requires no co-payment. Many insurance plans cover them.
During my training in internal medicine and in subsequent years of practice, the periodic exam was a recommended component of outpatient care and an accepted part of care in military and public hospital clinics. The prevailing idea was that the exams detected a disease without symptoms before it could undermine health and while it was curable.