A British perspective

I applaud Dr Howard-Tripp for articulating the view that the full annual physical is largely a waste of time.¹ I have a slightly unusual perspective on this, as I came from the United Kingdom, which does not have a cultural tradition of annual physicals, to Canada, which does.

I clearly remember the first patient I saw on my first day practising medicine in Canada, in a remote clinic in western Newfoundland. She was a morbidly obese 18-year-old who arrived asking for her “annual bloodwork.” I did not understand her request and I had no idea why she had come to see me. I looked in her chart—there was no mention of any medical condition, such as diabetes, which might require periodic bloodwork, although I could see from her morbid obesity that she was at high risk of developing diabetes. She looked at me and probably thought, “What planet has this new doctor come from?” This consultation did not have a satisfactory ending for either of us. She was followed by a steady stream of obese Canadians with no other identifiable medical pathologies, all wanting their “annual bloodwork.” This was completely different from anything I had experienced in the United Kingdom.

By the end of that first day, and with some help from the clinic secretary, I finally understood. The cultural expectation in the remote Newfoundland community in which I had landed was that almost everyone would become obese, starting in childhood. Obesity was therefore seen as a normal body shape. In order to maintain good health (so said the cultural belief) patients must go to the doctor and have an annual physical, of which the most important component was the bloodwork. If the results came back normal, this proved that you were healthy and no lifestyle changes were needed, and the process would be repeated the following year.

My impression is that despite the obsession with “annual physicals” and “annual bloodwork,” Canadians are generally less healthy than the British, who do not expect an annual physical because they believe the doctor has more important things to do. It also seems to me that in some communities (such as those in western Newfoundland), the annual physical can be counterproductive in terms of health outcomes because it diverts patients from what they really need to do, which is make lifestyle changes.

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