Do You Need an Annual Physical Exam?

Many patients ask me how often they need to see me, their family doctor? The answer is: that depends on your age, sex, personal and family health history, and whether or not you have symptoms or disease that require assessment. There is no "one-size fits all" answer to how often people need to be seen by their primary care providers.

The "Annual Check-Up"

Some patients are used to having an "annual physical" exam and a full panel of bloodwork and investigations every year. While this "more is better" approach might have been standard in the past, the traditional annual physical examination of asymptomatic adults is not supported by evidence of effectiveness to prevent or catch disease, and might result in harm. It should not be a regular activity.

There is better value in a periodic (ie, according to risks and specific test intervals) preventive visit with a primary care health professional (eg, family physician, nurse practitioner, nurse) to provide preventive counselling, immunization, and known effective screening tests.

Instead of routine annual, blind testing, we should instead focus on preventive measures which actually do have good evidence to improve your health and longevity, which include things like appropriate age- and sex-related screening, immunization, support with smoking cessation, low-risk alcohol consumption, prescribing and optimizing physical activity, healthy nutrition habits, and reducing obesity-related risks. This approach is not cookie-cutter, and customizes how and when we evaluate your health, considering your values and individual risk factors.

An annual head-to-toe annual physical exam and unguided investigations in adults without symptoms is not based in science and is not necessarily bad for our health, and can actually cause harm.

Periodic Health Evaluation

A science- and evidence-guided approach to preventing disease and improving wellbeing is to encourage moving more, healthy eating, decreasing stress and being opportunistic about making positive change. In an asymptomatic individual, this is called a Periodic Health Evaluation (PHE), and may occur annually or every few years, depending on which of these realms of your lifestyle and health you may need more support with. You may or may not requires a physical exam or tests at the PHE.

What About Screening?

When it comes to screening exams like the pap smear, blood pressure monitoring, and specific screening or blood tests, these are recommended at specific intervals based on age, sex, and other risk factors. I use the electronic medical record in the office to send reminders of when these investigations are due for you, and will notify you accordingly to keep you up to date. Children are seen more frequently for vaccines, evaluation of their growth and development, on a standard schedule.

Here's a helpful video by Dr. Mike Evans on the topic of how more isn't always better when it comes to exams and investigations in asymptomatic people:

Other Resources:

Periodic preventive health visits: a more appropriate approach to delivering preventive services. From the Canadian Task Force on Preventive Health Care

Richard Birtwhistle, Neil R. Bell, Brett D. Thombs, Roland Grad and James A. Dickinson

Canadian Family Physician November 2017, 63 (11) 824-826;