Ask Doctor K: Annual checkup is a disease preventative measure

DEAR DOCTOR K: I’m 73 and in great health. Do I really need to have an annual physical?

DEAR READER: Let’s start by defining “great health.” I would define it as having no known chronic (ongoing) illnesses. However, most people your age have at least one chronic illness, such as high blood pressure. People with chronic illnesses need to be checked out at least once a year, and usually more often.

Even if they don’t have any chronic illnesses, I ask my patients to come in for a checkup every year. That includes asking and answering some questions, a physical examination and some screening tests.

The questions probably are the most important part of an annual checkup. For example, I remember a man in his 50s who had no chronic conditions and exercised every day. He had a healthy diet – he was a vegan. When I asked him if he had been having any bothersome symptoms, he answered “no,” but hesitated just briefly before saying it. So I pushed him: “Even a mild symptom that’s not very bothersome, but that is something new?”

He replied: “Well, sometimes I get this tingling sensation in my feet. It comes and goes.”

That gave me an idea, and influenced what I did on the physical examination.

There is not a lot of evidence that a complete physical examination is valuable. In fact, an analysis of 14 trials that included more than 180,000 patients did not find that a yearly general health checkup decreased the risk of death or illness.

I always examine the heart, lungs, abdomen and skin. Even this limited examination is of unproven value. But I’ve discovered irregular heart rhythms, mild asthma and the occasional skin cancer.

But when a person has a symptom, parts of the physical examination can be extremely valuable. In my patient with the tingling sensations, I took a tuning fork and whacked it to make it vibrate. I asked him to close his eyes and to tell me when he felt the vibrations touch his skin. When I placed the tuning fork on his ankles, he said nothing.

During an annual checkup, it is important for adults to get several types of immunizations every so often and a flu shot every year. I checked my patient’s immunization record and gave him a flu shot.

Then it was time to order tests. The screening tests that I prescribe during an annual checkup didn’t turn up any problems in this person, this year, but they are effective in catching (and sometimes curing) diseases in an early stage, such as various types of cancer and heart disease.

I added a blood test for vitamin B12 to the screening tests in my patient. His symptom of tingling, his inability to feel the vibration of the tuning fork, and the fact that he was a vegan made me suspect that his vitamin B12 levels were low — and they sure were. Fortunately, vitamin B12 pills prevented what could have been permanent damage to his spinal cord.

So, I’d advise you not to skip an annual visit to your doctor. You don’t need to have every nook and cranny of your person probed every year. But you do need certain questions asked, screening tests performed and immunizations given.

This column originally ran in October 2014.

Dr. Komaroff is a physician and professor at Harvard Medical School.