COMMENTARY

The Death of the General Physical Exam

A Best Evidence Review

Charles P. Vega, MD

Disclosures

March 05, 2013

In This Article

The Study Design and Results

Researchers focused only on randomized trials that compared an intervention of general health checks with no health checks. Study participants were at least 18 years of age and unselected for specific health risk factors, and interventions were performed in settings outside the hospital. Observational studies were excluded because of the risk for selection bias, as were studies limited to examinations of adults aged 65 years or older because health checks in this population frequently used more intensive and specific interventions.

General health checks were defined as screening examinations for multiple conditions, not just one particular disease state. The primary outcomes of the review were total mortality and disease-specific mortality. Researchers also evaluated rates of major health events, new diagnoses, admission to hospital, disability, patient peace of mind, self-reported health, absence from work, and the use of healthcare resources. Meta-analysis was possible only for the primary outcomes.

In all, 14 trials with a total of 182,880 participants provided data for study analysis. The duration of follow-up varied from 1 to 22 years. Health screening took place in a variety of settings. Overall, the risk for bias in the included research was low to moderate. Two studies were biased toward a negative result, whereas 1 study appeared to be biased toward finding that general health checks were effective.

Nine studies examined overall mortality as an outcome, and general health checks did not influence this result (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.95-1.03). There was no heterogeneity among studies for this outcome. General health checks were also ineffective in preventing cardiovascular mortality (RR, 1.03; 95% CI, 0.91-1.17) and cancer mortality (RR, 1.01; 95% CI, 0.92-1.12).

These cause-specific mortality outcomes were associated with more heterogeneity among studies. One-time health checks were associated with a trend toward a higher risk for cancer mortality, whereas a series of checks promoted a nonsignificant trend toward a lower rate of cancer mortality.

Major health events, such as myocardial infarction, were less commonly reported, but general health checks had no significant effect on the rate of these events. However, general health checks were associated with a higher incidence of chronic disease, because screening tests found patients who were previously undiagnosed. Rates of hypertension and hypercholesterolemia increased after general health checks in one study, and the overall rate of chronic illness increased in another. Two of 4 trials that tracked the use of antihypertensive drugs noted an increase in their use after implementation of general health examinations, but no study evaluated the overall use of medications.

There were few data on the effect of general health checks on admission to hospital, disability, worry, absence from work, or number of additional physician visits to generalists or specialists. Of the 4 studies that evaluated participants' self-reported health, 2 demonstrated that general health checks were associated with improvements in these reports. However, there was a high risk for bias in both of these positive trials.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....