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Should Your Patients Have an Annual Check-up?


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Should patients come in annually for a physical exam in addition to an ADHD symptom review?

The authors of a commentary in the New England Journal of Medicine have argued against the practice of an annual check-up, especially for adults, citing the possibilities of inaccurate test results and the risk of unneeded medical intervention in otherwise healthy individuals. This raises patient health risks, they state, and increases costs in the medical system.

“[T]he annual physical may actually be harmful,” argue Ateev Mehrotra, MD, MPH, and Allan Prochazka, MD. “Some aspects of traditional annual physicals, such as the comprehensive physical exam (which might, for example, detect thyroid nodules) and routine tests (such as urinalysis), have low specificity, which means that most positive results in asymptomatic patients will be false positives.”

By scheduling physicals three years apart, the authors explain, health care providers could be better able to meet their patients’ health care needs.

“Reducing the use of annual physicals could also save money and time,” the authors write. “Reducing the number of physicals could free up another societal resource—primary care providers' time. Approximately 10 percent of all visits with primary care physicians are for annual physicals, which might be crowding out visits for more urgent health issues.”

About a third of adults see a primary care provider once a year for a physical. Children tend to see a primary care provider once a year or more. Many sports and school activities require additional checkups.

Most individuals diagnosed with ADHD have at least one visit a year with their prescribing professional. Often, children and teens will be seen more frequently, allowing their prescribers to observe more closely how well they are doing on the medication. Some insurance companies require a doctor visit for a medication check to monitor height and weight and check heart health before the physician can refill a prescription for ADHD medications. Meeting with patients more than once a year can give the prescriber and patient an opportunity to discuss the medication’s effects and monitor any changes in symptoms or behaviors.

Regular check-ups can also help to prevent adverse reactions or alert providers to a change in the patient’s well-being.

"When individuals take the time to have their yearly examinations and other preventive services, it opens the door to early detection should a major health issue be present," says Carolyn Cooper, medical director at the Center for Healthy Living at Purdue University. "Preventive care in general also helps identify patients who are at high risk for a disease and allows time to implement specific preventive steps to help ensure their best health possible."

The Centers for Disease Control and Prevention website notes the importance of health care providers and their patients meeting annually for a check-up. The website provides the following list of questions health care providers and medication prescribers and their patients should discuss:

  • Has your patient noticed any body changes, including lumps or skin changes?

  • Does your patient continue to take her medication as prescribed?

  • Is your patient having pain, dizziness, fatigue, problems with urine or stool, or menstrual cycle changes? Is your patient experiencing any side effects related to ADHD medication or other prescribed medications?

  • Has your patient changed his eating habits?
  • Is your patient experiencing depression, anxiety, trauma, distress, or sleeping problems not related to medication?

Each patient’s healthcare needs are different. An annual office visit can help to meet those needs by providing you with needed information to guide your patient and evaluate the effectiveness of medications. The American Academy of Private Physicians does suggest patients younger than 30 might be scheduled for a physical every other year, but patients older than 40 should be seen yearly. When it comes to an individual’s health care, it’s most important to take the patient’s needs into consideration when planning for the next office visit.

Tell us what you think. Comment on this article.


This article appeared in ADHD Weekly on October 20, 2016.
     


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