Normalizing Good Health

"With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial."
Researchers at the Nordic Cochrane Centre in Copenhagen

 As part of the negotiations between the province's health professionals and the Ministry of Health in arriving at a workable strategy that would bring them to an agreement over the contentious issue of cut-backs by the Ontario Health Insurance Plan in reimbursing doctors for services, a long-overdue and sensible recommendation by the Ontario Medical Association has resulted in a bit of prioritizing.

It has become routine within the medical community for physicians to recommend to their patients annual general physical check-ups.  A strategy devised, they say, to ensure that any latent health issues are detected in good time and do not become urgent as a result of having been overlooked.  The old adage of "a stitch in time saves nine".

With that annual check-up came a plethora of tests of various types and dimensions to be undertaken at some considerable cost to the system.  Tests to determine the presence, or lack of, of various types of chronic or underlying illnesses beginning their initial course, with the idea that if they are caught early, they can be more easily managed before they mature to full-blown panic issues.

"The annual visits will still be there, you'll get all the tests that you need.  But we are personalizing it so that if you need more tests you'll get more testing, and if you need fewer tests you'll get fewer tests", assured Health Minister Deb Matthews.

This agreement between the ministry and the province's doctors is said to have a value of $11.1 billion annually; part of the "modernization" of the annual health examination to personalize it to individual needs, reducing the incidence of unnecessary tests and procedures.  Makes good sense, doesn't it?  So why is this a new initiative, rather than already standard practise?

People's health situations are all different, reflecting lifestyle, personal commitment, genetic inheritance, age; presence/absence of chronic ailments - and so needless to say, one size does not fit all.  Little wonder the costs associated with public health care represent such a huge proportion of government outlay, straining the provincial budget.

Fees paid to doctors for physicals will, as a result, be reduced for healthy adults since their annual visits will take less time on average.  Family doctors, it appears, were the most forceful advocates of routine health exams reflecting the needs of patients with varied degrees of health presentations.  "They came forward with this idea that if we actually look at the evidence, maybe we're over-testing people ... it's best for patients", said the minister.

Actually, what might be even better for patients is to respect their intelligence.  People don't need to be encouraged to seek annual health examinations.  Our overworked health professionals with their busy practises have resulted in a shortage of doctors and a large contingent of people without the services of a family practitioner.

It makes common sense that people see a doctor when there is a reason to do so.  If someone feels ill, if something appears to be medically amiss, see a doctor.  And leave it at that.  Fewer doctor calls, more time for physicians to see a wider range of patients by eliminating those annual check-ups.  And there appears to be research that supports that more relaxed attitude.

A recent study undertaken by Danish researchers pooled data from 14 studies incorporating 280,000 randomly assigned people.  One group was asked to have regular checkups, the other encouraged to see a doctor only when needed.  From the information available the data gleaned presented the conclusion that annual physicals do not appear to reduce deaths from cancer or heart disease.

Those annual check-ups, however, can add to stress levels.  So who needs them, until and unless they really do need them?

The Ontario Medical Association represents the interests of 25,000 doctors currently practising in the province.  And they estimate that each succeeding new year brings an additional 600 doctors to the practise of medicine, finally beginning to keep pace with the growing number of Ontarians.

This kind of practical change could be even more streamlined by reducing the emphasis on regular annual health check-ups, other than for those whose medical conditions require them.  While other, healthy individuals could simply see their family doctors if and as required.  Makes good sense.