Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticleDebates

Rebuttal: Should we abandon the periodic health examination?

NO

Cleo A. Mavriplis
Canadian Family Physician February 2011, 57 (2) e43;
Cleo A. Mavriplis
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: CMavriplis@bruyere.org
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Dr Howard-Tripp raises a very important issue concerning our need to promote cost-effective use of health resources in our health care system. However, ensuring appropriate patients have periodic preventive health examinations is essential to better managing health care costs in our aging society. For example, in 2001 the economic burden of physical inactivity and obesity in Canada was $5.3 billion and $4.3 billion, respectively.1 More efforts to prevent these conditions and their associated chronic diseases are essential, and the periodic health examination (PHE) provides an opportunity to make such efforts.

Dr Howard-Tripp argues that 21.4 million appointments a year and $2 billion in consultation costs could be saved and put to better use if we abolished the PHE. This is an oversimplification of the situation. It assumes that the millions of PHEs performed yearly in Canada are worthless. As mentioned previously, relationship-building and prevention are the focus of these visits. Physicians are often attending to chronic disease and multiple health issues during these appointments as well. They are not empty, test-burdened visits.

I must disagree with the premise that efforts to improve the PHE and make it more evidence-based have failed. The articles quoted as evidence used American data and were published 6 to 8 years ago. For more than 10 years, family medicine residents have been trained to perform age- and sex-specific assessments in lieu of a generalized head-to-toe examination. Frequent articles and continuing education presentations address this issue. I have presented at several continuing medical education conferences where family physicians were very interested to learn that they did not need to do certain tests during the PHE, which can save time. Many family physicians in Ottawa and across the country use the preventive care checklist of the College of Family Physicians of Canada2 or other methods to deliver an appropriate periodic health assessment. Research would help us delineate what proportion of family physicians have not made the switch to more evidence-based practices and why.

What I do think need to change are the billing requirements. This will ensure that physicians adjust their practices. A preventive care assessment should be defined as the recommended preventive maneuvers by age and sex, including a brief lifestyle and psychosocial assessment as necessary, as screening for depression is a recommendation. These longer visits should not have to include functional inquiry or “examination of all body parts” as stated, for example, in the Ontario schedule of benefits,3 as these are not evidence-based practices.

One size does not fit all. If the PHE does not work for some, then other methods to deliver preventive care can be used. But an updated periodic preventive health assessment does address an important need in health care. With proper billing incentives this could be an even more powerful tool.

Footnotes

  • Competing interests

    None declared

  • These rebuttals are responses from the authors of the debates in the February issue (Can Fam Physician 2011;57: 158,160 [Eng], 159,161 [Fr]).

  • Cet article se trouve aussi en français à la page e45.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Katzmarzyk PT,
    2. Gledhill N,
    3. Shephard RJ
    . The economic burden of physical inactivity in Canada. CMAJ 2000;163(11):1435-40.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Dubey V,
    2. Mathew R,
    3. Katyal S,
    4. Iglar K
    . Preventive care checklist forms. Mississauga, ON: College of Family Physicians of Canada; 2007. Available from: www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=1184. Accessed 2011 Jan 12.
  3. 3.↵
    1. Ministry of Health and Long-Term Care
    . General preamble in the Ontario schedule of benefits for physician services under the Health Insurance Act, effective October 2010. Toronto, ON: Government of Ontario; 2010. Available from: www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html. Accessed 2011 Jan 12.
PreviousNext
Back to top

In this issue

Canadian Family Physician: 57 (2)
Canadian Family Physician
Vol. 57, Issue 2
1 Feb 2011
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Rebuttal: Should we abandon the periodic health examination?
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Rebuttal: Should we abandon the periodic health examination?
Cleo A. Mavriplis
Canadian Family Physician Feb 2011, 57 (2) e43;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Rebuttal: Should we abandon the periodic health examination?
Cleo A. Mavriplis
Canadian Family Physician Feb 2011, 57 (2) e43;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Should we abandon the periodic health examination?
  • Should we abandon the periodic health examination?
  • Réfutation: Devrions-nous abandonner l’examen médical périodique?
  • PubMed
  • Google Scholar

Cited By...

  • Comprehensive preventive care assessments for adults with intellectual and developmental disabilities: Part 2: 2003 to 2014
  • Google Scholar

More in this TOC Section

  • Will the new opioid guidelines harm more people than they help?
  • Will the new opioid guidelines harm more people than they help?
  • Should peanut be allowed in schools?
Show more Debates

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2022 by The College of Family Physicians of Canada

Powered by HighWire