Preventive health care, not examination

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  1. James A. Dickinson, MB BS CCFP PhD FRACGP

+ Author Affiliations


  1. Calgary, Alta

The debate over the periodic health examination1,2 published in the February 2011 issue of Canadian Family Physician uses the wrong title. The first report of the Canadian Task Force pointed out that we should discuss not the annual physical examination, but rather the periodic health examination, and later the title changed further to “Canadian Task Force on Preventive Health Care.”3 Not annual, not focused on examination, and indeed not necessarily requiring a special visit.

When we examine the activities that are worth doing4,5 to help people stay healthy in Canada, a country in which we can largely take public health for granted, the most important preventive measure is patient behaviour followed by immunizations, supplements, and a few key investigations; examination barely features at all. Blood pressure can be taken by clinic staff, and in the United Kingdom Papanicolaou tests are seldom done by GPs but are done instead by their practice nurses. A top-to-toe examination is a waste of time because none of the maneuvers have much value in detecting the earliest stages of disease (and to do them properly takes more time than is available in most preventive consultations) and because it creates inappropriate expectations that divert attention from useful activities. Most people who present for periodic health examinations are the ones least likely to need them: the non-smoking, abstemious, exercising, upper- or middle-class native-born Canadians.

Residents from across Canada who join our program report that most of their clinical teachers and preceptors in family medicine teach them to perform this wasteful ritual, more than 25 years after the Canadian Task Force was the world leader in critically appraising it. Why is knowledge dissemination so poor? It might be pleasant for doctors to develop relationships with healthy people, as Dr Mavriplis suggests, but it is at the expense of those who really need our time and the benefits of a good doctor-patient relationship: those with serious chronic illnesses and major health risks.

We must focus on the most effective methods of providing preventive health care and health care in general. This requires focusing on those who are ill, or most likely to develop sickness, and on activities that really work, not just those that make us feel good.

References

  1. ?
    1. Howard-Tripp M

    . Should we abandon the periodic health examination? Yes [Debates]. Can Fam Physician 2011;57:158, 160, 164, 166. (Eng);. Fr.

  2. ?
    1. Mavriplis C

    . Should we abandon the periodic health examination? No [Debates]. Can Fam Physician 2011;57:159, 161. (Eng); 165,167 (Fr).

  3. ?
    1. Canadian Task Force on Preventive Health Care [website]

    . History of the task force. Ottawa, ON: Canadian Task Force on Preventive Care; 2010. Available from: www.canadiantaskforce.ca/history_eng.html. Accessed 2011 Mar 9.

  4. ?
    1. Dubey V,
    2. Glazier R

    . Preventive care checklist form. Evidence-based tool to improve preventive health care during complete health assessment of adults. Can Fam Physician 2006;52:48-55.

  5. ?
    1. Dickinson J,
    2. Aghoram R

    . Preventive care in family medicine. Calgary, AB: University of Calgary Department of Family Medicine; 2010. Available from: www.ucalgary.ca/familymedicine/preventive. Accessed 2011 Mar 17.