Response

I thank Drs Dickinson,¹ Gray,² Bernstein,³ and Greiver⁴ for their contributions to the debate on the future of the periodic health examination (PHE).

Dr Greiver raises some interesting points. In the preceding 3 years she performed approximately 500 PHEs per year. I suspect that these are annual examinations of the same individuals year after year, and if so, what preventive care do the other 800 patients in her practice receive? Again I suspect that they receive preventive care as a component of acute care visits. Why would it not be possible, then, to schedule evidence-based preventive care at appropriate intervals, during visits for regular care, for all of her patients?

Five hundred PHEs a year translate to 1 full day per week, time that would be better spent on improving “open access” for all of her patients, and then some.

Dr Greiver also indicates that certain investigations and blood tests are ordered “because of custom or patient expectations.” Why is the “custom” of an annual PHE so difficult to shake in favour of more evidence-based practices? The security associated with this annual ritual is ill-founded, and falsely reassures both physicians and patients alike. I wince at the suggestion that this is the only opportunity to properly communicate with patients, and again wonder about the state of physicians’ communication with those who do not attend for PHEs.

The Canadian Medical Association is promoting dialogue on improving health care through the use of best practices and better use of available technologies. Unless change takes place from the ground up, renewal becomes mere political rhetoric. I urge all family physicians to take up the challenge and become the instruments of much needed change in the Canadian health care system.

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