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1 Question, 5 Answers: How Is the Traditional Checkup Changing?

We all know that we’re supposed to go to the doctor once a year for a checkup — after all, the annual physical exam has long been the bedrock of primary care. But it’s also a subject of debate in healthcare, as more experts are questioning the checkup in its traditional form and pushing to modernize the standard “say ahh” formula. 

Some research, including one 2012 study from Denmark, suggests that on average, patients who go in for yearly tune-ups aren’t in better health and don’t live any longer than their appointment-skipping counterparts. Still, many doctors and nurses say that checkups come with hard-to-measure health benefits, such as the positive psychological effects of one-on-one communication, compassion and touch.

We asked five primary care professionals how checkups are changing and what role they should play in our modern-day healthcare system. Here’s what they said.

Dr. Ankoor (Neil) Biswas, MD

Aurora St. Luke’s Medical Center, internal medicine faculty, primary care specialist
Milwaukee, Wisconsin

I definitely feel like routine medical checkups have changed a great deal in the last decade. There is much less emphasis on physical exams and a higher emphasis on ordering labs and “checkbox”-centered discussions, such as vaccinations. In addition, due to modern documentation requirements, the provider spends quite a bit of time facing the computer typing. This really changes the dynamic of an office visit from a decade ago. Hopefully voice transcription services or more broad utilization of scribes will make documentation more efficient, thus allowing the provider to spend a few extra minutes with the patient.

Head-to-toe physical exams seem outdated in a routine checkup, and to be honest, I don’t actually think most providers do extensive physical exams during the average medical checkup. Heart and lung exams, as well as basic skin checks, are appropriate. But again, even if there is an abnormality detected on a heart or lung exam, it’s almost always followed up with an echocardiogram or chest X-ray.

Technology is very accurate for certain diagnoses, but it is often cost-ineffective and is not adequate for psychosocial diagnoses. Moreover, the main purpose of primary care is preventive care. Technology, while being useful for screening, plays little role in changing behaviors that can lead to disease. Traditional checkups also allow physicians to talk to patients about trends in their health, like rising weight, rising blood pressure, increased stress levels, depressed mood, etc. That can predict future disease. Without these checkups, we will only treat patients at the time of their acute illness, when it is much more expensive and much more difficult to treat them.

The main issues in family medicine tend to deal with excessive paperwork and patient phone calls, unrealistic expectations with regards to patients seen per hour, and less compensation compared to specialists. I think more research should be done on finding ways to make some of these issues easier to deal with and “leveling” the playing field with regard to specialists and primary care physicians. Primary care is the most important field in medicine, but most physicians go into medical or surgical specialist fields or hospital medicine. One of our main focuses should be finding ways to make primary care more attractive to our most talented physicians and spending resources to make that happen.

Dr. Yami Cazorla-Lancaster, DO, MPH, MS, FAAP

Pediatrician, T. Colin Campbell Plant-Based Nutrition Certification, Food for Life instructor
Yakima, Washington

In the field of pediatrics, we’ve always been very focused on prevention, as our patient population is generally very healthy. Yet now that we are seeing an increase in chronic diseases in younger people, we are spending even more time talking to parents about lifestyle habits they can implement to keep their children healthy for life. I actually love checkups because I get to spend time counseling parents and answering their questions about feeding, development and other issues that wouldn’t get addressed at sick visits.

Face-to-face interaction, warmth and safety are difficult to replicate with technology. There are many things that we can improve or achieve with technology, but I still value being able to sit down with my patients and their families and give them the time and space to express their worries and fears. Being with them also allows me to better express my empathy and compassion. I very much believe in the value of traditional wellness checks, and I am so fortunate that they’re a big part of what I do as a pediatrician.

We need to find a balance between providing “sick care” and guiding our patients. We already spend a lot of time and money diagnosing disease and searching for treatments for disease. This is necessary, but we are not spending enough time or energy investigating the best ways to encourage and assist our patients with their lifestyle choices and habits. In addition, because as physicians we tend to “prescribe” rather than coach our patients, we may not always empower or motivate our patients to make changes that benefit their long-term health and wellbeing.

Dr. Khalid Saeed, DO

Internal medicine specialist, lead physician at Tampa Bay Concierge
Tampa Bay, Florida

As a society, we’ve all been ingrained with the notion that once a year, we must visit our primary care doctor for a checkup, the reason being that a yearly physical is a cornerstone of good care. However, for healthy, asymptomatic individuals, there is evidence that these annual exams may not be necessary. Some experts say that you don’t need to worry about annual physicals if you’re following the recommended guidelines regarding risk-stratified health screening testing. That’s not to say there’s no use for the annual checkup, just that it may not be needed every single year.

This is a fundamental change in the thought process we’ve been taught as physicians, and not everyone is ready to embrace it. For one thing, the traditional checkup provides benefits that technology can’t. Regular checkups help maintain a relationship with your doctor, as well as allow you to receive recommendations based on your age and risk of disease. Cancer screening, cardiovascular risk assessment and immunizations are the high-value items from an exam.

The other change is a move away from the traditional head-to-toe exam followed by ordering a battery of standard laboratory tests and imaging studies. A more modernized approach focuses on the specific needs of the patient by taking into account their age, gender and medical history. This cuts down on wasted time and healthcare dollars, and allows you to focus more on preventive counseling and lifestyle changes, which have been shown to make an impact on the patient’s current and future health.

While some may argue the actual exam needs to be improved, I would say the better path is to make the entire practice more efficient. We live in a digital world and we should embrace it. Technology can eliminate errors, improve patient access and save time. In my practice, we have automated many functions that would usually require a phone call.

Still, the building of trust in the patient-doctor relationship during an in-person exam leads to better counseling and improved patient compliance. It’s a relationship that’s difficult to build via a telemedicine session or over the phone. At the end of the day, there is something personal and tangible conveyed in a sincere hug or a compassionate touch.

Dr. Abraar Karan, MD, MPH

Author, Protecting the Health of the Poor: Social Movements in the South, and internal medicine resident at Brigham and Women’s Hospital, Department of Medicine, Hiatt Residency in Global Health Equity

Many primary care physicians now recognize two main things about routine medical checkups: First, we rarely find anything of concern in otherwise healthy, asymptomatic patients when we do more than the standard healthcare maintenance measures. Secondly, when we do find things we weren’t looking for, they may cause unnecessary further testing and may in fact end up being harmful or expose patients to unnecessary radiation or more.

We also, however, appreciate the social forces that contribute to disease, the challenges of medication adherence, and the role of the doctor-patient relationship in establishing trust. For all of these reasons, being in close communication with patients is increasingly important for primary care physicians or other members of the medical team.

Most health issues occur not when we see the patient in our clinic, but when we don’t see them. Their home environments, daily choices and stressors, food, exercise, mental health, social connectedness — we can’t address these all in a 15-minute visit. This is why having a team with significant outreach, especially for medically complex patients, is critical.

Overall, the face-to-face contact with a patient is priceless, and as doctors, we can have a huge impact on motivating our patients, advising them on difficult choices and dispelling myths that are propagated in the media about health-related matters. However, time is a limited resource. One must ask whether that face-to-face time should be reserved for every patient each year in the form of a physical exam, or allocated to more medically complex patients who may need it more frequently. I personally think the latter, although it would be great to see all of my patients more often.

Jill Beavers-Kirby, NP, DNP

Author, Pain Management Decoded: Surviving and Thriving With Chronic Pain, Advanced Family Medicine
Grove City, Ohio

Routine medical checkups are still basically the same as they have been over the last decade or so. There have been some revolutions, such as changing guidelines for immunizations, preventive health screenings and treatment recommendations. Yet there are several benefits that a traditional checkup provides that cannot be achieved through technology.

Laying hands on a patient to actually note the temperature and texture of the patient’s skin is not achievable through technology. Giving my patient a hug because they’ve been laid off from their job cannot be provided via technology. It’s also the perfect time to talk to my patients about other aspects of their lives. There is a definite connection between mind, body and soul. For example, when someone is worried about something, it can have an adverse impact on their physical health.

Many people want the one-on-one, in-person treatment that they’re paying for. And as a nurse practitioner, I am solely focused on doing what’s best for my patients, as well as coming up with creative ways to help them live healthier lives.

Plus, a routine checkup is the perfect time and place for me to talk to my patient about their blood pressure or diabetes, as well as recommend the appropriate immunizations. And it’s not uncommon for a routine checkup to reveal something more serious, such as low blood counts or a suspicious mole. These routine checkups can detect something early before it becomes a bigger problem to treat.

Still, checkups could be more effective. Good, thorough checkups take time, but I believe they become more efficient with experience. You learn to move from one topic to another and the whole process flows more smoothly.

Responses have been condensed and lightly edited.

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