The Weird Theatrics of Your Annual Physical
Nothing produces a feeling of self-satisfied “adulting” quite like actually remembering to go in for your annual physical. Comprised of a familiar series of pokes, prods, and questions seemingly designed to make you feel inadequate, this yearly dose of medical attention is, for many young and/or healthy people, the only time they spend dealing with healthcare professionals. But what if we told you that your annual physical was about as medically-efficacious as that tube of CBD toothpaste you bought at Trader Joe’s?
All scientific evidence suggests that your yearly visit to your primary care physician is functionally useless. According to one meta-study from 2012, annual physical exams did not make otherwise healthy adults less likely to become sick or die. Meanwhile, the sum of medical literature published over the second half of the 20th century led University of Pennsylvania provost and oncologist Ezekiel J. Emanuel to deem the yearly physical “basically worthless” in a 2015 New York Times editorial. This isn’t some far-out argument made by a few renegade doctors, either. In fact, the United States Preventive Services Task Force, an independent body that makes evidence-based recommendations about preventive care, does not advocate annual medical checks for otherwise healthy adults. Similar Canadian guidelines stopped recommending that yearly one-on-one date with your doc back in 1979.
But what of the disease detection? Unfortunately, these exams offer surprisingly little in that arena. Emanuel argues that, after screening thousands of healthy people for disease, you’ll discover a few dozen folks who might have a disease, of whom one or two can actually realize health benefits from said detection. This number is, obviously, not insignificant if you’re person #1 or person #2. But statistically, it seems like a pretty dismal way of maintaining our collective health.
So, what do annual physicals functionally accomplish? Think of it as an exercise in medical magical thinking: One study found that these appointments can reduce worry by assuring healthy people they are, in fact, healthy. So, best-case scenario, the average hypochondriac’s anxiety might decrease. Worst case scenario? According to Emanuel, otherwise healthy patients might “end up with complications and pain from further screening or confirmatory tests” intended to detect diseases. Then, there are the problems of false positives — or when a test mistakenly indicates that the patient has a disease or condition — which can lead to incorrect or unnecessary procedures. And, of course, there’s also the equally-troubling converse problem of a false reassurance, which offers a clean bill of health to someone whose disease is merely not-yet-detectable.
At the same time, annual checkups are running insurers and patients the hefty price tag of over 5 billion dollars annually, according to a 2007 Harvard study led by Ateev Mehrotra. (That’s not even counting the less-readily-measurable lost time and productivity resulting from otherwise healthy adults taking the afternoon off simply to get their vitals checked.) What’s more, Mehrotra argues that these appointments weigh on physician availability, preventing them from spending their time on sick patients who genuinely need treatment.
So, if these appointments offer little in the way of medical benefits and come at a significant cost and burden to our medical system, why has the annual physical persisted as a standard for health maintenance?
That question is pretty convincingly answered by author Barbara Ehrenreich in her 2018 book, Natural Causes, which argues that the “annual physical exam” should be seen less as a medical process than as a ritual or even a “spectacle designed for entertainment.” Over the course of our evolution, rituals have ranged from maypole dancing to shamanistic healing practices, and have served a wide variety of purposes, from catharsis to community cohesion. Ehrenreich notes that certain medical procedures — in this case, the annual physical — should be seen as ritual because they are “no more scientifically justified than the actions of a ‘primitive’ healer.”
What is actually accomplished by the ritual of stripping down to a hospital gown and having various parts of your body poked, prodded, or diligently squeezed? Ehrenreich would argue that it serves a significant social and performative purpose, rather than a medical one, in that it normalizes physical transgressions typically seen as inappropriate. Essentially, the squirm-inducing invasiveness of your exam serves to confer the medical authority of the doctor, even when there’s no scientific reason to stick out your tongue for the nice doctor.
Even some doctors who defend standard medical practices such as the annual physical agree that the performative, ritualistic element of medical treatment is hugely important. Stanford medical professor Abraham Verghese argued in a TED talk, patients have come to expect, even demand, some of the invasive interactions associated with a medical exam, and that they will actually express concern and surprise when, say, a stethoscope is placed over their hospital gown rather than on their skin. What’s more, Verghese says, these physical transgressions — having intimate parts of their body touched — is crucial to the establishment of doctor/patient bonds. The intimation, then, is that the slightly unpleasant, occasionally-violating nature of our annual checkup is an important part of a carefully-choreographed ritual of healthcare — one in which we submit to ritualized humiliation in exchange for a clean bill of health.
That isn’t necessarily a bad thing. Ehrenreich agrees that performance is, indeed, an important part of medical treatment — think of the relief conferred onto a child when their mother kisses a booboo. She also cites studies that show the important placebo effect of caring, empathetic medical care. Put simply, people like feeling cared for, and enjoy having the concern and attention of a qualified doctor. However, Ehrenreich poses the compelling question: Isn’t there a better way to offer social and medical support for healthy adults than the exorbitantly expensive, decidedly unpleasant annual physical? Or put more simply: If a big part of medicine is ritual, can’t we come up with a ritual we don’t dread?
