Medicine’s ‘Cost-Cutting’ Focus May Shortchange Physical Exams

With doctors "running to the next appointment," physical examinations often "fee[l] more like a pit stop: Check the cholesterol, check that blood pressure and ... it's back to the races," leaving patients to wonder, "Did we cover everything?" the Los Angeles Times/Philadelphia Inquirer reports. According to public health researchers, the answer is "probably not." Dr. Paul Frame, a family physician in Cohocton, N.Y., who has served on the U.S. Preventive Services Task Force, which sets guidelines for physicals, said, "A lot of what happens during a good physical is counseling and history-taking, and no one wants to pay for you to sit around and talk for 20 minutes." A 1998 Consumer Reports analysis of government health data found that the length of a physical exam averages only about 18 minutes. In Ohio, doctors who have studied exams "say it typically lasts only 12 minutes." The Consumer Reports study also "shows what happens when doctors are rushed, or not careful." Among patients studied, only half of women older than age 40 received a breast exam during their doctors' visit, doctors advised only one in three smokers to quit and just one in five physicians talked to patients about diet (Lee/Carey, Los Angeles Times/Philadelphia Inquirer, 6/4).

It's the Law
In New Jersey, state lawmakers passed the New Jersey Health Wellness Promotion Act last November, "guaranteeing" millions of state residents a free, comprehensive annual exam that includes more than a dozen preventive procedures. The law applies to patients age 20 or older who are covered by commercial managed care or fee-for-service insurance plans. Dr. Donald Louria, chair emeritus of the Department of Preventive Medicine and Community Health at the University of Medicine and Dentistry of New Jersey, lobbied state lawmakers to require doctors and health plans to "devote time solely to prevention." He said, "I was simply appalled at how few people were getting any real preventive advice or procedures at all." The provisions of the New Jersey law "go well beyond" guidelines set by the U.S. Preventive Services Task Force, requiring not only "widely accepted" screening procedures, such as Pap smears for women and blood pressure testing, but also testing regimens "whose value has not been proved," such as yearly blood tests for cholesterol and glucose. Mohammad Akhter, executive director of the American Public Health Association, called the law "a good first step in turning doctors' attention to preventive care," citing the law's "unusual" requirement for counseling in a number of areas, including breast or testicular self-examination, smoking cessation and weight control. "I think it's remarkable that they got so much counseling into the law," Dennis Fryback, a researcher at the University of Wisconsin and former member of the U.S. Preventive Services Task Force, said, adding, "It's hard to convince people how valuable that is, and it's terrific that they recognized it" (Lee/Carey, Los Angeles Times/Philadelphia Inquirer, 6/4).