Primary prevention

The periodic health examination or “annual physical” has fallen into disfavor amongst funders, where these regular, scheduled longer visits have been removed from some provincial payment schedules, and health services researchers whose research does not demonstrate any benefit from performing annual physicals. We are now discouraged from providing these services to our patients. I believe this advice does a disservice to both our patients and the system; limiting opportunities for primary prevention of chronic illness.

The problem with the research lies in the definition used for the annual physical in the research. Data included in these studies tend to overlook what is actually accomplished during these visits. As a result there is huge variability in the visits included. The benefit that may occur from visits focused on primary prevention of chronic illness are included with other less beneficial visits with the resulting lack of demonstrable benefit.

There are things we can do as family doctors that are likely to benefit our patients’ overall health. Patients do not come to us spontaneously to ask if they should quit smoking. Almost one in five Canadians still use tobacco regularly with huge impacts on their health. There is strong evidence that the interventions available to us are effective in helping a significant percentage of patients quit tobacco. Patients do not voluntarily seek advice on their level of physical activity. But an annual visit provides the opportunity to discuss the patient’s level of physical activity with the goal of helping the patient develop a healthier lifestyle.

Lifestyle change, whether it be an improved diet, increased physical activity or quitting smoking, is rarely easy. It takes a concerted effort by the patient and professional support increases the likelihood of success dramatically. The annual physical is the visit that provides the opportunity to initiate the discussion about lifestyle behavior change with patients at risk for harm based on their lifestyles. This is our realm of influence as family doctors. We need to seek out opportunities to have these discussions with our patients. We can make a difference in their lives by addressing these risks for harm.

Dr. Alan Katz is a practising family physician in Winnipeg Manitoba, Director of the Manitoba Centre for Health Policy, Professor in the Departments of Community of Health Sciences and Family Medicine at the University of Manitoba, and Manitoba Health Research Council Chair in Primary Prevention Research. Katz research is focused on primary care delivery, including quality of care indicators, knowledge translation and disease prevention.

Competing interests: Dr. Katz receives funding from the Research Manitoba and the Heart and Stroke Foundation as the Manitoba Research Chair in Primary Prevention.