Most people are still used to getting an annual physical exam by their doctor. In fact, some people think that their doctor is lazy, negligent or just not a very good doctor if they don't get examined.
There are many instances where the physical exam is absolutely essential. If you complain to your doctor you were exerting yourself and you fainted, you can bet they will listen to your heart and with good reason!
Right now we are talking about annual physical exams in people without symptoms. You come in to your doctor's office and you are ready for your annual physical. Your doctor or nurse takes your blood pressure, does your height and weight, gives you a vaccination, reviews your cholesterol, asks how you are feeling. You feel ok, no symptoms other than this mole on your arm, your doctor looks and says no need to biopsy because it is benign but you do need to be using sunscreen. He says you are doing well other than you can reduce your cardiac risk by losing a couple pounds and he makes some diet and activity recommendations. "See you in two years."
"Wait a sec, this is my annual physical, aren't you going to listen to my heart and my lungs, test my reflexes"?
Well no actually. Many smart people over the years looked at this question and continue to look at questions regarding ordering tests in people without symptoms. A physical exam is a test. If we are going to order a test, there should be a reasonable chance we will find something that we are going to do something about. It should be more good than harm. And in Canada, it should be a good use of taxpayer money because there are a finite number of dollars for healthcare. If we do lots of things that give no benefit, there is less money for the things that really help people. It is often a lot easier to see the things with benefit when the money isn't there to pay for them than count up all the wasted money on investigations with little to no value.
The latest research on periodic health exams, because that is what we call them these days, is that they don't need to be annual and they don't need to be physical. They should have a point; they should make you live longer or better. They should be to find something early like cancer or diabetes or high blood pressure when you can't feel anything wrong, before your health starts failing and it is too late to turn it around.
In general, screening physical exams where doctors listen to your lungs and test your reflexes and all that just don't make the cut when it comes to providing much benefit to you. It may make you feel cared for by your doctor and I think part of the doctor patient relationship is strengthened by the physical exam. Good old days, Norman Rockwell, whatever. That doesn't mean we should do things that don't have evidence to say they help you.
Think about it this way. If your doctor is paid to do things that are or quite possibly could be useless, is this a good thing? Obviously no. This means that the money isn't being spent on something useful and furthermore, doctors themselves are finite and so is the amount of hours in a day. Doctors are expensive to train. Med schools are subsidized by government. In our community there are many people without family doctors and that really sucks because they pay taxes like everyone else.
If doctors did less things that were of dubious value, they could ideally have more time and could take on and care for a few more patients. If you are a patient without a family doctor then this might make the difference between having a doctor and not.
There is also a more subtle aspect to physical exams in people without symptoms and that is a false sense of security. If you are overweight, you smoke, you drink too much and you don't exercise, your doctor could do a physical exam and find nothing "wrong" with you. That is a problem because now you think that your doctor just examined you and despite all the things he told you not to do and all those unhealthy habits, you are no worse for wear, you think. Well you certainly are worse. Certain things are just hard to measure until they are really bad and to balance the risk of the test we often need a reason to do it (chest pain). You would be better served if that extra time was spent educating and counselling you on strategies for quitting smoking for example.
In this clinic we try our best to focus on things that make you live longer or feel/live better while eliminating all the other stuff, but no one is perfect. The evidence isn't perfect. The evidence changes. The best we can do is keep learning and stay up to date and do the best for our patients. This is the long answer for why I don't listen to your lungs every year.
-Brad White