I read the debate on abandoning the periodic health examination1, 2 (PHE) with interest. I can see the value of both arguments.
We might be overusing this examination. The PHE is the most common reason patients visit my office. I have a practice of 1300 patients; in 2008, I provided 564 PHEs. This was reduced to 503 in 2009 and 414 in 2010. Most PHEs are accompanied by investigations, such as blood tests, because of custom or patient expectations.
I am not convinced that every patient should have a PHE every year. It is not clear to me what the frequency of PHEs should be. I agree with Dr Howard-Tripp that electronic medical records (EMRs) can divorce some preventive services from the PHE; for example, we mail reminders for Papanicolaou tests or mammograms to patients who are overdue and the EMR has point-of-care reminders. We use automated reminders for chronic disease management, such as neuropathy examinations for patients with diabetes. The value of the PHE as an organizational tool might lessen as use of the EMR improves.
I value the added time to build a relationship with the patient that the PHE provides, as Dr Mavriplis discusses. As well, it is helpful to review aspects of the cumulative patient profile, such as family or social history. Although I try to discuss tobacco use during routine visits, this is most consistently done at the PHE; the visit is a good fit for addressing lifestyle risk factors such as diet and exercise.
I do not think a periodicity of a year is appropriate for PHEs. Several screening tests are recommended every 3 years (eg, fasting blood sugar and cholesterol levels for men aged 40 years or older). Trying to lengthen the interval between PHEs, perhaps to every 2 or 3 years, might be a pragmatic way to reduce the number of unnecessary investigations and visits while still providing an appointment focused on reviewing the cumulative patient profile, addressing prevention, and maintaining relationships with our patients.
I have reduced the annual number of PHEs in my practice by 27% since 2008. This has improved access for my patients—I am now using an open-access booking system (for same-day appointments). I think trying to reorganize a practice with a goal of reducing the number of low-value PHEs might be a pragmatic way to address this issue.
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