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Family Health Magazine
FAMILY MEDICINE

The New, Improved Check-Up
It’s not the same old physical exam

We have all been taught that an annual check-up with our family doctor is one of the best ways to stay healthy. However, both times and health care have changed. The old check-up examined the body, and may have included a few tests. Now, reviews are designed specifically for you and your health risks. Check-ups were once a yearly intervention applied in the same way to everyone. Now, they are based on what each individual needs. With these changes, you may be assessed more or less often. It all depends on your personal health and risk factors.

New directions, new terms

Evolving ideas about health care have meant changes to the annual check-up. Evidence-based medicine (EBM) is now being used. This involves reviewing all of the new science about health interventions. Standard practices have been studied to see if they are good for people, do nothing one way or the other, or actually do harm. It is possible for unnecessary investigations or inappropriate reassurance to do damage. Evidence-based medicine combines patient values with the best research and the knowledge of health experts.

Preventative health assessment is also being applied to the annual check-up. Doctors are using time with a patient to reflect on what might prevent problems in the future. For instance, immunization might prevent disease, while tests may find it in the early stages. Some early detection tests are for cancerous diseases, others for chronic illness.

The periodic health assessment

Once, regular doctor appointments were known as an annual check-up. Now, we use the term ‘periodic health assessment’ or ‘periodic health examination’ to describe similar activities that protect our health. The timing varies depending upon your needs. If you are healthy and have no known risk factors, fewer appointments are necessary. With a chronic disease, more assessments are needed, perhaps as often as every three months.

The periodic health examination (PHE) is intended to prevent specific diseases and promote health. PHEs involve a group of activities, including both primary and secondary prevention. Assessments are designed to assess your risk of developing disease, or to identify early disease before there are symptoms.

Primary prevention uses immunization, reducing risks and changing behavior to ward off illness. Secondary prevention attempts to find those who have no symptoms but are in the early stages of disease. Finding a problem before symptoms appear often allows a much better chance of recovery.

These new ideas about health care have already significantly changed the old annual check-up. More changes are likely as we discover what makes a true difference to our health.

What has happened in Canada?

Both Canadian and international understanding of what is important in health assessments have improved, thanks to the Canadian Task Force on Preventive Health Care. In the past, assessments included immunization where evidence suggested this would be effective. A physical exam of some type was usually done, although the benefit of this remains uncertain.
In 1979, the Task Force recommended that routine check-ups be abandoned in favor of selective packages designed to protect health. These packages would be tailored to various health needs at different stages of life. How often assessments are done and what activities are included would depend on evidence. Any given test, immunization, advice or therapy should have evidence to support its use. The following questions would be used as part of developing a strategy.

• Efficacy – Does early detection of a disease or risk factor mean better health for those who follow the health advice given?
• Effectiveness – Does early detection of a disease or risk factor help?
• Efficiency – Is the right strategy being made available?
• Frequency – If a detection test done today is negative, when should the next test be done?

Since these recommendations were made in 1979, the periodic health assessment has changed greatly. Some effective strategies are put in place during appointments with your family doctor. Others will occur through public health clinics and provincial programs. Examples include breast cancer screening, Pap screening (to find cancer of the cervix), and colorectal cancer screening programs.

The table below shows some examples of effective, efficient periodic health assessment strategies. These have been shown to improve the health of those who have them done at recommended times.

Surveys suggest that most people do not understand how current periodic health assessments work. Many still expect a traditional annual ‘check-up.’ Once an explanation is given, people realize the new approach is likely better.

With a periodic health assessment there is still ample opportunity for patients and doctors to discuss issues and build relationships. As with the old annual check-up, the doctor is allowed enough time to truly understand your full health status. This helps develop a trusting relationship, which will serve both of you if illness occurs or a difficult decision must be made.

All of these changes in health care may mean that your next annual check-up is not what you have come to expect. The traditional physical may be different, or perhaps even disappear. It may be replaced by interventions and tests tailored to you. Rest assured that the changes you see have been proven to benefit your long-term health.