Money on Health Care

How necessary is that annual physical?

Gregory Warner Nov 20, 2010
Money on Health Care

How necessary is that annual physical?

Gregory Warner Nov 20, 2010


Tess Vigeland: So now I have a message for all those listeners who are not sick. You still see a doctor, right? For a yearly check-up? The general medical exam is by far most common reason that people go see a doctor.

Even our health reporter Gregory Warner got one, right Gregory?

Warner: I did! I went to Dr. Steve Peitzman, he’s a doctor at Drexel University. Peitzman is also a medical historian — we’re going to get to that in a minute.

Anyway, as he’s examining me, he admits something that I don’t think I’d realized before.

Peitzman: Open your mouth, say the traditional ritual ‘ah.’

Warner: Ahhh.

Peitzman: O.K. that’s all pretty worthless because I wouldn’t expect to find anything.

Warner: No wait, you said it’s worthless? The whole throat thing is worthless?

Peitzman: Well you have no sore throat. Ii’m going to find anything that’s preventive in looking at your throat or your eyes.

Warner: But you do it anyway?

Peitzman: Well, I sort of do it anyway.

Even the parts of the exam that don’t make clinical sense for every patient.

Peitzman: So the parts that don’t make too much sense are in fact what many, many people associate with being examined. The stethoscope on the chest, listening to the heart or lungs.

And if Peitzman does that stuff even when not medically necessary, it’s because he knows that the physical is half check-up, half comfort ritual.

Peitzman: Right.

The annual physical, though, did not start that way. It started in the 1870s by doctors working for life insurance companies. It was not about treatment.

Peitzman: They wanted to screen potential customers with the idea of not writing a policy on somebody who had a heart murmur, who had an enlarged liver, who had a wheezing or crackling sound in the lung that could be tuberculosis.

Pre-existing conditions, in other words. Then came a Philadelphia doctor named George Gould, and he changed all that.

Peitzman: Gould really did have this idealistic notion that a careful examination might detect disease in a pre-symptomatic state. As he referred to it, the symptom of the symptom, and wouldn’t it be possible to abort the illness if you could detect it very early? He doesn’t give too many examples, but he tosses out that concept very strongly.

On June 7th, 1900, the American Medical Association, the AMA, gathers in Atlantic City for its annual conference. George Gould gives a speech.

Peitzman: Urging that physicians broadly pick up the concept of the periodic full examination. So here’s what he said in this address. He said: It is the shame of medicine and the basis of quackery, this symptom-treating and symptom-killing.

That summer day, Gould offered the AMA a new definition of the doctor. He’s the person who tells you if you have a problem. Before you know if you have a problem.

Peitzman: In my mind, the general practitioners in that audience would be raising the question: What is this guy talking about? Who wants to pay a fee to come and see me when they’re feeling fine, and I’m going to take 20 minutes to poke and prod them and gather a little bit of urine. Who’s going to pay me for that?

In 1900 when Gould gave his speech, that was a good question. But pretty soon, lots of people were willing to pay. By 1923, the U.S. Public Health Association could launch a nationwide campaign, with the slogan: “Have a Health Examination on Your Birthday.” Their goal: to perform 10 million examinations in the first year.

Everybody say ah!

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