Routine physicals not associated with improved morbidity, mortality in nongeriatric patients

Routine physicals do not decrease morbidity or mortality and are unlikely to be beneficial, according to a new Cochrane review.

The review included 16 randomized trials comparing non-geriatric patients who got routine physicals (defined as screening for more than one disease or risk factor in more than one organ system) to those who didn't. Nine of the trials, with a median follow-up of nine years, collected data on total mortality, and in those trials, physicals were associated with a mortality risk ratio of 0.99 (95% CI, 0.95 to 1.03). Additionally, eight trials provided data on cardiovascular or cancer mortality. Physicals had no significant effect on death from cardiovascular disease or cancer (risk ratios, 1.03 and 1.01, respectively).

The reviewers also tried to look at other possible effects of the routine physical but found insufficient data. One trial found a 20% increase in new diagnoses associated with physicals, and others found increased occurrence of hypertension and increased use of antihypertensives. Potential negative outcomes, such as follow-up procedures, specialist visits and psychological effects, were not reported in many of the trials. In general, the reviewers found the included trials to have methodological problems. Results were published in The Cochrane Library on Oct. 17.

The results show that routine screening physicals have not worked as intended, the researchers concluded. One possible reason is that in the older studies, the health checks were very broad and fewer preventive treatments were available. It's also possible that the screenings are used by the patients who need them least, because they are already attentive to their health.

Another issue is that physicians already screen many of their patients who are likely to be high risk based on clinical indications, said the review authors, reducing the benefit of more widespread screening. Although the review's results indicate that this widespread screening is not effective (and should be avoided by public initiatives), that does not mean that physicians should refrain from clinically motivated examination and preventive treatment, they said. Future research should try to identify the effects of physical examination screening for specific diseases and conditions and use mortality, rather than any surrogate marker, as an outcome, the authors advised.