Thursday, July 28, 2005

Cheney's Annual Physical

How better to mix medicine and politics than by discussing Dick Cheney's physical condition? Straight From the Doc has analyzed the Veep's workup test-by-test.

Basically, he got what anyone else would have gotten with a few exceptions: an upper endoscopy (esophagus, stomach, upper intestine) done for unknown reasons, and a vascular study showing some dilations of arteries in his knees. Also, since he smoked he should have gotten an ultrasound to screen for an abdominal aneurism, though that's not mentioned in the article.

Some such as NCPA have argued that annual physical exams without a medical complaint are a waste of resources:

An expert committee sponsored by the federal Agency for Healthcare Research and Quality found little benefit in many of the tests commonly included in a typical physical exam for symptomless people:

It found no evidence that routine pelvic, rectal and testicular exams made any difference in overall survival rates for those with no symptoms of illness; furthermore, such tests can lead to false alarms, necessitating a round of expensive and sometimes risky follow-up tests.
And even many tests that are useful, like cholesterol and blood pressure checks, need not be done every year.
Other time-honored procedures -- listening to hearts with a stethoscope, thumping chests and looking at eyes, ears and throat -- provide no medical benefit for healthy patients with no symptoms.
Many doctors do a careful physical exam on a patient's first visit to serve as a baseline. But on subsequent visits, say groups like the Agency for Healthcare Research and Quality, patients would be better off if doctors spent their time counseling them on such things as stopping smoking, eating a healthy diet and drinking moderately, using seat belts and having working smoke alarms in their houses.

It is a danger in today's thirst for evidence-based medicine to weight the measurable as more valuable than the unmeasurable. It is very difficult to measure the increased compliance with medications, the lower malpractice suit rates, the efficiencies of continuity of care, and the better patient satisfaction overall that come from a good relationship with one's physician. The annual physical is a key factor in building that relationship, and should not be discarded in the quest for better institutional statistics measuring up to outcome goals devised by nonclinical management.


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