The routine annual comprehensive physical examination (PE) became a fixture in American
medical practice in the 1940's. By the 1980's many influential professional groups, including
the American Medical Association, the American College of Physicians, the United States
Preventive Services Task Force (USPSTF) and the Canadian Task Force on Periodic Health,
recommended that this approach be replaced by periodic screening, counseling and PE tailored
to a patient's age, sex, risk factors, and symptoms as elicited by the medical history and review
of systems (Oboler 2002). Furthermore, these recommendations tacitly or explicitly endorse
the concept that, for screening purposes, only those components of the PE that accurately and
effectively detect conditions for which early diagnosis is known to lead to improved patient
outcomes should be routinely offered.
Consistent with this tailored and evidence-based approach, Medicare currently offers a
free initial "Welcome to Medicare" visit which includes a medical history, recommended
immunizations and screenings and "further tests depending on your health and medical history".
The only components of the PE recommended for everyone are measurement of blood pressure,
vision, weight and height (www.medicare.gov/welcometomedicare/visit.html).
Nevertheless, most adults in the US believe that annual comprehensive physical exams are
important; a 2002 study showed that more than 90% endorse the value of routine examination
of the heart, lungs, abdomen, reflexes and prostate (Oboler 2002). Moreover, as recently as
2005, many physicians also endorse the complete annual physical examination for a variety of
reasons including perceived benefits to the physician-patient relationship, patient expectations
for a yearly "physical," fear of malpractice litigation, and compensation (Frame 1995,
Prochazka 2005). The purpose of this review is to determine whether the routine annual physical
examination results in improved outcomes for asymptomatic adults.
PRIMARY: To evaluate the value of the routine (e.g. annual) physical examination in
asymptomatic average risk adults. Specifically, what components of the routine physical
examination are currently recommended by high-quality evidence-based guidelines or reports.
SECONDARY: To determine if designating a specific visit for the provision of evidence-based
preventive services (often referred to as a periodic health examination) increases the likelihood
that patients will receive these services.