This past weekend’s “Link Love” highlighted an article called “Rethinking Movement: Why You Should See a Physical Therapist Every Year.” Arguing for a systemic approach to movement and a deeper appreciation for the interconnections among the body’s neuromuscular, skeletal, cardiovascular and even endocrine functioning, professor emerita of physical therapy, Dr. Shirley Sahrmann proposes that taking a more preemptive approach to movement (a.k.a. prehab) throughout life can head off injury, osteoarthritis, chronic pain as well as the common surgeries and other intensive or pharmaceutical treatments related to these conditions. Whether you’re an elite athlete or a channel surfer, she claims an annual check-up by a physical therapist should be routine practice. Having seen so many injuries and pain issues as a trainer (and suffered from them myself), I find her proposal very compelling. More than that, however, her reasoning opens up a larger question: what really should we be monitoring on an annual basis?
As many of you know by now, I tend to embrace the devil’s advocate role, particularly in questioning conventional wisdom. It’s not that I’m out for blood or have a chip on my shoulder (although blatant misinformation does get under my skin). I simply don’t believe in accepting a truth or practice on the sole rationale of “that’s just how it’s done.” Standard health care parameters are no exception here.
When we think about preventative care or maintenance checks, what makes the most sense? Currently, protocol is figured mostly around certain collective risks like hypertension, heart disease and specific cancers. As I’ve argued in the past, even these attempts miss the target, however, with their focus on elementary cholesterol panels and single screenings that may say more about a person’s mood that day or white coat syndrome than their actual state of well-being. And aside from honing some of those exam parameters, where else are we missing the mark – either by focusing on the unnecessary or by missing out on pertinent areas?
In the last few years a number of experts, armed with some persuasive research, have suggested doing away with the standard yearly check-up period. Most notable is a 2012 research review done by the Cochrane Collaboration, an international group of medical researchers. They analyzed 16 peer-reviewed studies with a follow-up range of 4-22 years involving nearly 200,000 people (excluding any studies with subjects 65+) to see whether annual exams lowered the rate of mortality, disability or hospitalization. As another earlier review had shown, the evidence suggested no on all counts. The Cochrane review also found that annual physicals had no effect on “patient worry, unscheduled physician visits…or absences from work.”
On the other hand, major concerns exist around the cost, anxiety and even harm imposed by indicated overdiagnosis with annual check-ups of asymptomatic, under-65 individuals. Based on missing or unclear data in the original studies related to these concerns, the Cochrane Collaboration review didn’t assemble statistics for these areas, but its authors did echo an earlier review’s statement that routinely checking asymptomatic, low-risk people sets up a situation in which “potential for harm is likely to exceed the potential for benefit.”
The researchers note that the Canadian Task Force on the Periodic Health Examination advised against routine annual physicals as far back as 1979. The United States Preventative Service Task Force stopped recommending standard annual visits ten years later. What both groups suggested instead was “focused health checks guided by patient-specific risk factors.”
Before we imagine what that could be, let’s look at the standard “check-up” protocol for adults in the U.S. for a minute.
Height and weight
Blood pressure check
Cholesterol (often only “total” non-fasting cholesterol or a simple rather than comprehensive panel)
Blood sugar (maybe – with fasting blood sugar even rarer)
Pap smear for women
Discussion of diet and exercise habits
I’m sure we’ve all been there – many, many times. Some of us would claim better experiences with these appointments than others. If we have questions about coming changes or would like to optimize health for certain circumstances (e.g. menopause, fertility), an annual discussion with a doctor can be helpful. If that person knows our medical history and has a good bedside manner, even better.
Regardless of the advice or any treatment offered, placebo research suggests that the care of an attentive individual – particularly one we deem knowledgeable as well as understanding – can confer a measurable benefit to emotional as well as certain physical measures of well-being. In keeping with that principle, those who have seen naturopaths or other “non-standard” wellness care providers often emphasize the duration of time and depth of discussion as one of the most helpful or nurturing elements of that relationship.
So, what does all this point to? What should we desire and expect in terms of preventative care and useful consultation?
For the Cochrane Collaboration authors, a central criticism of the standard check-up procedure was its “generic” nature. How can preventative care offer more genuinely helpful screenings and conversation?
While I’m interested more today in posing this as a question for our community discussion (I’m looking forward to reading your perspectives and anecdotes in the comment board), I will propose a few points based on my specific angle of experience.
I’d suggest we miss a significant chance to help educate and support people in terms of basic lifestyle change. How many doctors include five minutes or less of discussion on stress, nutrition, fitness, sleep and other self-care considerations? I’m not even trying to put physicians in the hot seat here. Many would explain their time is limited and already tightly circumscribed by a clinic protocol not of their individual choosing. Likewise, most doctors have very limited training in nutrition and exercise, let alone other areas of wellness practice. They know the conventionally recommended fundamentals (and some know and embrace a deeper understanding of more updated, results-oriented diet and exercise research – even Primal principles).
That said, what would an annual check-up be if we could re-envision it as a varied, open-ended “check-in” with additional elements? How about a postural alignment check-in physiotherapist even if you’re not having physical pain? How about a consultation with a fitness professional for fitness testing and exercise planning? How about the chance to meet with a mental health professional or complementary therapy practitioner for stress relief or other concerns? What about meeting with a dietitian for food allergy or nutrient deficiency testing or for help redesigning your daily diet?
How about the ability to see a wide variety of professionals within particular fields of expertise – for both consultation and testing interpretation? How about making the overall process patient-directed or at least including a meaningful patient-directed component to regular care? What could health care look like – and what would compliance and outcomes be – if patients were expected to design their own health care in the form of a healthy living plan and then given choice in how they allocated insurance or other medical related savings/resources?
What if patients were more involved in creating their own risk profiles based on not just age and family history but also on dietary and other lifestyle elements – and were held more accountable for seeking out care to monitor and manage their noted risks and/or conditions with more targeted care and detailed screenings? How about funneling money that would otherwise be put into standard check-ups be directed toward more updated screenings for risks that fit a patient’s personal profile?
Again, my intent here is to pose more questions than provide answers. I consider this to be one of the most essential conversations we can have in considering our individual choices (and future policy) around health care – how to get people to re-envision wellness and vitality and to cultivate the genuine health integrity that will allow them to take ownership of their well-being.
I’d love to hear your thoughts on the problems of annual exams – and the possibilities in re-envisioning them. Also, if you have related questions or ideas you’d like to see in future posts, share those as well. Perhaps this might open an interesting conversation and even post series.
Thanks for reading, everyone, and have a great end to the week.
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Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.