Annual Physical Exam: Arts and Science

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Medicine is a schizophrenic profession trying to balance art and science. It gets especially difficult when the science half tries to prove the art of little value. Doctors from the University of Pittsburgh and Stanford University have decided that the annual doctor's visit may be a waste of time. They published their research in the Archives of Internal Medicine and suggested that all the stuff done at the yearly visit could be done more efficiently. They say that preventive services can be done outside the traditional annual physical exam. Their science is probably right, but the art gets in the way.

I have a great mechanic for my car. His garage on 19th and Jackson is third generation, and his daughter works beside him in one of the three bays. Every few months when I get the routine oil, lube, and filter, he checks the fluid levels, the tire pressure, and all the sundry things that I don't know or particularly care about. I enjoy the few minutes we talk about the weather or his grandkids, and I like that he's part of the neighborhood. I especially appreciated the time when the "check engine" light came on just before a weekend getaway and he made time to get me on the road. We have a relationship.

I have a family doc as well. I guess I could be my own, but then I would have a fool for a patient. I show up every year to say hello and tell him that I feel healthy and all is well. He asks about my family and how work is going. We chat about getting older and my thoughts about end of life care. He understands that his role is to grow old gracefully along with me and to be my advocate should the need occur. My preventive screening could be done more efficiently and more cost effectively by a healthcare extender, but the half hour we spend talking about my wishes and wants for the future will be priceless in 10, 20, or 30 years. When my medical and life crises happen, and they will, I hope he will be there understanding what I want, even if I may not remember or be able to tell him. We have a relationship.

That relationship which develops between patient and physician is more than the technical aspects of checking blood pressure or cholesterol levels or managing diabetes medications, flu shots, or immunization records. Time is a special gift that people have to listen and understand each other. Knowing a patient allows the doctor to broach topics that are uncomfortable and taboo.

This is my life in the ER - it's 2am, an ambulance rolls in with a patient who is deathly ill, and decisions need to be made quickly. What should we do if your heart stops? Do you want to be put on a ventilator if you stop breathing? Bedside discussions with little time and no background are tough for the patient and family, and can be overwhelming. But many times, the answers while given in a weeping voice, are clear: "Our doctor has talked with us about quality of life, advanced directives, and what our wishes might be when bad things happen and this is what we've decided."

How much money is that calm worth in a time of crisis? The science would say too much. I would suggest that it is priceless.

Reference: University of Pittsburgh press release, September 24, 2007.