Before the pandemic, did you see your doctor for a yearly appointment even if you were feeling well?
If so, you have plenty of company. The yearly routine doctor visit is a ritual going back decades. It's sacred in the eyes of many. But research suggests its value varies for adults.
Questioning the annual wellness check or routine physical exam
An annual checkup doesn't seem to move the needle on a few important measures, such as deaths, strokes, and heart attacks. Its value is probably especially limited for young, healthy individuals.
Yet a recent review suggest routine medical visits may lead to detection of chronic disease (such as high blood pressure), response to risk factors (such as lowering cholesterol to prevent cardiovascular problems), and higher rates of recommended screening (such as colonoscopy).
And there may be other, hard-to-measure benefits:
- the reassurance value of spending time with a trusted health professional who is focused on your health and how to maintain it
- a strong relationship can make it easier to share sensitive, but important, health information in the future
- for some, the "laying on of hands" — the physical connection of the examination itself — may be particularly powerful.
Routine health visits in the future
During the first wave of the COVID-19 pandemic, many doctors' offices were closed, so there was little choice but to delay non-urgent medical appointments. But as it became clear the pandemic would continue dragging on, phone and video-based medical care became a logical alternative to in-person care. These telehealth alternatives worked for many people.
Home monitoring of health, such as blood pressure checks or wearable gadgets to monitor heart rate, has become more common and less expensive. So, some people can manage elements of their annual checkup at home, without actually seeing their doctor.
That leads me to wonder: now that healthcare providers' offices are largely open again, will we all go back to routine in-person visits each year? Or, might your annual check-up include virtual options, such as one or more of these approaches:
- A phone or video call to review symptoms and discuss healthcare goals. Afterwards, your doctor can order screening tests and plan to review the results by mail, email, or another phone call.
- A phone or video call followed by an in-person physical examination at a clinical center where — with your permission — a nurse or physician's assistant can examine you as your doctor supervises through a video link.
- A multidisciplinary video visit that gives you the opportunity to connect with multiple providers. This might include a nutritionist, pharmacist, physical therapist, and mental health expert. Specialty care, such as a cardiologist or lung expert, might be included if needed.
Of course, if a routine visit becomes non-routine — for instance, a screening test shows a concerning abnormality — or if new and bothersome symptoms develop between visits, a traditional in-person visit would likely be the best next step.
The pros and cons of virtual care
Big advantages of virtual care are:
- Convenience. Not having to travel to the doctor's office, deal with parking, or sit in a waiting room (with other patients who may be sick) is a big deal.
- Easier access. When the nearest doctor is hours away, virtual checkups can provide a way to receive high-quality medical care that might not otherwise happen. Virtual care may also allow more frequent check-ins to monitor progress and reassess health goals.
- The possibility of real-time multidisciplinary care. Pilot studies of people recovering from COVID-19 and other conditions suggest that such care is feasible, but we'll need additional research to know if it's effective and sustainable for routine medical check-ups.
- A more relaxed visit. For some, a virtual visit from the comfort of home is much less stressful than the doctor's office. Some doctors have found that their patients seem more forthcoming about health concerns during virtual visits than they had been in past office visits.
But virtual care also has drawbacks:
- lack of physical examination by a healthcare provider
- more difficulty interpreting nonverbal communication. For example, a person might be nervously wringing their hands or tapping their foot, but this could be missed on a phone or video call.
- a detrimental impact on the doctor-patient relationship. Studies are incomplete on this point, but it's possible that the connection between doctors and patients will suffer if we move too far away from in-person visits.
There may be other advantages and disadvantages of virtual care we haven't discovered. I look forward to hearing about research in the coming years assessing the impact of virtual care.
When do you need in-person care?
Even if a routine annual physical isn't necessary, plenty of folks should get in-person care. These include many people with
- Chronic illnesses. For example, you might need in-person care at regular intervals if you have diabetes or rheumatoid arthritis, although some evidence suggests virtual care may be just as good for short periods of time. If you've had cancer, you may see your medical team or have tests scheduled at intervals.
- New symptoms or signs of a possible health problem, such as a breast lump or trouble breathing.
- Conditions requiring a procedure or surgery, or a specific exam, such as a breast or prostate exam.
And, of course, urgent or emergency care requires immediate, face-to-face medical evaluation and treatment.
The bottom line
If your doctor suggests a routine yearly medical visit, find out why they feel this is important. And ask whether you can partly or fully accomplish the same goals by phone or telehealth, or safely push your routine visit out a year or more. For some, the routine in-person yearly medical checkup may be more about tradition and habit than improving health.
Follow me on Twitter @RobShmerling