don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

The Annual Physical Exam, henceforth APE, has been a key part of medical practice for decades. It remains popular to this day, though it has many detractors. The APE involves a visit with a health care provider for the primary purpose of assessing overall health and risk factors for disease that warrant either treatment or early intervention. The APE continues as a high cost to business and insurance companies, despite the skepticism about its value because of costs, the fact that it diverts medical resources and because it so often leads to unnecessary additional testing and resultant false positives.

If the healthiest man or woman submits to enough different tests and boring details of family and social histories, some doctor somewhere will eventually find something wrong or at least suspicious—and more tests, procedures and maybe even surgeries will follow. I believe this is true no matter who presents for testing. For instance, if Michael Phelps went to a dozen doctors (disguised as an ordinary John Doe patient), half of medicos would recommend further tests due to concerns about excessive oxygen capacity, overdeveloped deltoids or maybe excessive flexibility.

More than 7000 articles have been written about the APE since 2006. Studies are reported on MEDline, the Health Technology Assessment Database and varied other National Health System databases in this country and the United Kingdom, Canada and Japan.

Recently, an article appeared in the Wall Street Journal authored by a physician named Benjamin Brewer (January 7, 2009) about the APE. It was entitled, "Annual Physicals Can Pay Unexpected Dividends." It raised more concerns about the APE than it satisfied, in my view.

Fortunately, the economic crisis has led to fewer APEs, as more doctors and worksite wellness managers openly question the effectiveness and value of the annual physical. Yet, many consumers, influenced by advertising and varied scare tactics about risk factors, still submit to annual testing and follow-up medical precautions.

One way to gain the best of both worlds, that is, discover genuine problem areas at minimal cost while shifting the focus from medical concerns to lifestyle choices, is to offer annual MENTAL exams, or AMEs. In fact, if I had my way, AMEs would replace APEs! 

Since REAL wellness is so much more than not being sick, AMEs could focus on different factors, explore different issues and change the focus from doctors searching for problems to consumers being guided to recognize opportunities.

Health system reform should thus include the transformed APE into an AME. That is, a shift from the existing focus on organ systems, disease detection, health screening, medications, control problems (blood pressure or lipids) and other medical factors to the consumer's mental state. If the consumer is not pursuing a REAL wellness lifestyle, that could be a mental issue—and such an issue is more consequential than mere physical risk factors. It affects attitudes and behaviors—and the consumer's quality of life.

In the Wall Street Journal article cited above, the physician suggested that he and other innovative, behavior-oriented proponents of annual checkups have changed the focus of the APE. Now doctors are urged to address more than simple medical issues. The doctor was quoted as follows: "I use it to build trust and rapport. That helps me to motivate, to provide hope and to persuade patients to face things about their health that they'd rather not. I do a comprehensive review of lifestyle..."  Just so. That is more than an APE—it's an AME, an annual mental exam.

The annual mental exam would be a REAL wellness check, conducted by professionals trained and certified to conduct REAL wellness assessments. The latter would feature lifestyle guideline recommendations. The AME would be less about negative risks than positive quality of life, with particular attention given to exercise/fitness, dietary habits and levels of functioning along a continuum of reason, exuberance and freedom to live the kind of life the client desires. Attention would also be given to meaning and purpose, a happiness quotient, ethical consciousness and other such consequential matters. Any patient or consumer not pursuing a wellness lifestyle might be considered a bit of a mental case, or simply someone who has not enjoyed the benefits of cultural and other supports needed to appreciate and act upon healthy choices.

So, I say, don't eliminate the APE—change it, as part of overall health reform into a mental, lifestyle-focused assessment and coaching opportunity. What a difference that would make in terms of lives and resources saved, unnecessary medical procedures avoided and health-enhancing behaviors adopted.

Be well. Always look on the bright side of life.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of adaptations and challenges. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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