This is a bit of a loaded topic and the authors are intermittently conflating "annual physical" with what is now better called a "periodic health maintenance visit".
Aside from semantics, a periodic health maintenance visit is intended to provide an opportunity for age-appropriate evidence-based screening and preventive counselling as well as minimizing loss to follow-up and missed screening opportunities (pandemic-related patient access issues has been a great reminder of why screening is important). How often and when to do this is debatable, but specific tests have recommendations (the USPSTF is a great source).
In contrast, palpating an abdomen in the hopes of opportunistically catching an asymptomatic tumor or putting a stethoscope on someone's neck to listen for carotid artery narrowing as part of an annual screening physical exam is arguably negligent and homeopathic at best. Other than blood pressure and BMI, I can't think of another component of the physical exam that would have potential clinical utility in an asymptomatic patient (granted my residency days in primary care are many years behind me now).
Using the article's example of an abdominal aortic aneurysm, we have evidence-based recommendations on screening[0] which notably do not include a physical exam.
Current recommendations (expert opinion, weak evidence) for periodic health visits will vary but are typically something like every 3-5 years for patients < 49* without chronic conditions and annually > 50 which coincides with roughly when we start to screen for most malignancies and worry about cardiovascular disease. There are many safe and useful investigations (e.g. colon cancer screening, cholesterol) and interventions (e.g. vaccines) that can be done in this visit so calling an annual visit 'bullshit' is facetious although this is very accurate for the physical part.
*Women between 40-49 should also be getting an annual mammogram although this does not necessarily need an associated visit.
As a layman (not a medical professional), I've never heard the term "periodic health maintenance visit" before reading this comment.
I've definitely heard "annual physical" and "annual checkup" before though. And that's what my insurance pays for once a year for free, in my understanding.
It seems like "periodic health maintenance" is necessarily a part of an "annual physical/checkup", just the same as a quick physical inspection is part of your annual as well.
But that Vox is ignoring the "periodic health maintenance" part?
> I've definitely heard "annual physical" and "annual checkup" before though.
"periodic health maintenance visit" or just "periodic health check-up" is more of the newer academic/formal medical term (for example on UpToDate which is a very strong authority in clinical practice) but in real practice (when I used to do this) we also used annual checkup or physical. This was both with patients and other health professionals, it's just easier and it doesn't make a practical difference to you or me but in the context this article they're mostly referring the actual old annual physical exam.
> It seems like "periodic health maintenance" is necessarily a part of an "annual physical/checkup", just the same as a quick physical inspection is part of your annual as well.
> But that Vox is ignoring the "periodic health maintenance" part?
Keep in mind this article was written in 2016. This is from the article (emphasis added):
>"Almost nothing in the complete annual physical examination is based on evidence"
I was in residency around then and it was in the early days of screening evidence and tests becoming available and cheap. This was before even all the fancy new colon cancer stool tests came out and it wasn't that long before this article came out. We were even routinely ordering unnecessary labs like screening liver function tests and checking urine (which still happens sadly) on 30 year olds once a year who are in completely good health.
I think when this was written the annual physical actually meant an annual physical with a laundry list of unnecessary labs, but it was transitioning to the period where we use those words to mean a visit primarily aimed at evidence-based primary/secondary prevention and during peak "Choosing Wisely" campaign to reduce unnecessary investigation. I think the authors agenda is positive but seems misleading in the context of 2023.
Honestly, in my opinion if you're palpating an aortic aneurysm these days you're practically a nutjob but people (and myself) were absolutely doing this circa 2016. This is what that looks like[0], so even if you have someone skinny enough that you can feel this through their abdomen (the aorta is in front of the spine) we're pretending this is anything more than voodoo when we have cheap ultrasound (if appropriate).
Aside from semantics, a periodic health maintenance visit is intended to provide an opportunity for age-appropriate evidence-based screening and preventive counselling as well as minimizing loss to follow-up and missed screening opportunities (pandemic-related patient access issues has been a great reminder of why screening is important). How often and when to do this is debatable, but specific tests have recommendations (the USPSTF is a great source).
In contrast, palpating an abdomen in the hopes of opportunistically catching an asymptomatic tumor or putting a stethoscope on someone's neck to listen for carotid artery narrowing as part of an annual screening physical exam is arguably negligent and homeopathic at best. Other than blood pressure and BMI, I can't think of another component of the physical exam that would have potential clinical utility in an asymptomatic patient (granted my residency days in primary care are many years behind me now).
Using the article's example of an abdominal aortic aneurysm, we have evidence-based recommendations on screening[0] which notably do not include a physical exam.
Current recommendations (expert opinion, weak evidence) for periodic health visits will vary but are typically something like every 3-5 years for patients < 49* without chronic conditions and annually > 50 which coincides with roughly when we start to screen for most malignancies and worry about cardiovascular disease. There are many safe and useful investigations (e.g. colon cancer screening, cholesterol) and interventions (e.g. vaccines) that can be done in this visit so calling an annual visit 'bullshit' is facetious although this is very accurate for the physical part.
*Women between 40-49 should also be getting an annual mammogram although this does not necessarily need an associated visit.
[0] https://www.uspreventiveservicestaskforce.org/uspstf/recomme...