During an Ask Robyn session – one of the membership benefits of the EmpowerEd program – a member asked which blood tests she should request from her GP when attending her annual check-up. Her question led into a broader discussion of whether having an annual check-up is a good idea in the first place.
To summarise my answer, the general consensus among medical researchers and advisory panels is ‘no’. (You can access my full response to the question, and all the references, on the EmpowerEd membership site.)
But how could this be? Surely an annual check-up would help to identify health problems in their early stages, facilitating more effective treatment and prevention of serious complications of the disease. (This is what doctors call ‘secondary prevention’ – managing an illness so as to reduce its impact on the sufferer; ‘primary prevention’ means stopping the disease from ever developing in the first place.)
It’s an appealing idea, but unfortunately the facts don’t support it. A review of 14 randomised controlled trials, including a total of 182,880 participants, found that patients who attended an annual check-up (defined as “a visit dedicated solely to preventive counseling and screening tests” – i.e. not for management of a pre-existing condition) were, compared to the control group who didn’t attend an annual check-up:
- 20% more likely to be diagnosed with a new condition over the course of six years;
- More likely to be diagnosed with high blood pressure and high cholesterol;
- More likely to be prescribed drugs for high blood pressure;
- Just as likely to be admitted to hospital, suffer a disability, worry about their health, be referred to one or more specialists, require additional visits to the doctor, or have to take sickness-related days off work; AND
- Just as likely to die from cancer, cardiovascular disease, or any other sickness-related cause.
Now what is the point of undertaking any form of medical testing or treatment, or for that matter, any health-related behaviour at all including eating better and exercising? I think it’s pretty obvious: to improve your health and well-being and reduce your risk of dying prematurely and/or horribly!
No intervention should be undertaken if it doesn’t tick these boxes, and annual medical check-ups clearly don’t. If you’re diagnosed with a chronic disease through an annual check-up, you’re just as likely to deteriorate from and die of that disease as if you never went for the check-up.
The authors of the study cited above – the Cochrane Collaboration, which is the world’s most independent and respected healthcare information research organisation – concluded:
“General health checks did not reduce morbidity [sickness] or mortality [death], neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased… With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.”
They also noted that appointments that included lifestyle counselling also did not result in decreased mortality – probably because doctors’ diet and lifestyle recommendations are so ineffective!
Neither the US Preventive Services Task Force, the Canadian Task Force on Periodic Health, nor the American College of Physicians recommend annual check-ups, based on evidence including the Cochrane review cited above, and a US health department report which concluded:
“Comprehensive routine physical examinations are not recommended for the asymptomatic adult, although many patients and physicians continue to endorse the practice.”
Yet, without quoting any evidence to support his position, the Australian Medical Association president, Dr Steve Hambleton, continues to insist that “it is vital that middle-aged Australians have regular check-ups with their family doctor.” Considering that his organisation represents the doctors who carry out check-ups, it doesn’t take a cynic to wonder whether there’s a conflict of interest in his support for a practice that does not offer any benefits to patients.
My take on the annual check-up is that it can have some benefit if it is focused on reviewing lifestyle behaviours that affect health. When I do a periodic check-up with clients who have recovered from whatever brought them to see me, I:
- Review their food journal and make suggestions for improvement, focusing on addressing practical considerations such as their level of cooking skills and the time they have available to prepare food;
- Discuss their exercise routine and modify it if required;
- Investigate their sleep patterns and develop a plan to address sleep problems if they become evident; and
- Help them develop a practical stress management plan, or tweak the one they already have.
I also encourage clients who follow a 100% plant-based diet to get a blood test for serum vitamin B12 every 1-2 years, in order to fine-tune their B12 supplement dosage. Other blood tests are simply not necessary if no new symptoms have developed.
Obviously, you should see a doctor if you develop a new symptom that is severe or persists for more than a couple of days.