Owasso Family Medicine Reviews Recent Study that Shows General Check-ups do not Reduce Sickness or Death

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A review of studies done to see if being invited to do a general check-up in the absence of symptoms had an effect on reducing sickness or death, showed there was no effect on overall risk of dying, nor specifically on the risk of dying of cancer or heart attacks or strokes says Owasso Family Medicine.

A review of 14 trials was published last week to see if there was a difference in outcomes in those people who were offered a health check-up in the absence of symptoms compared to those not offered one (http://www.ncbi.nlm.nih.gov/pubmed/23169868).

The theoretical benefit of preventive health check-ups is to reduce illness and prolong life – this is due to detection of elevated risk factors such as elevated blood pressure or high cholesterol, the treatment of which is supposed to reduce illness and prolong life. While this is not known to be the case, all medical interventions can lead to harm such as overdiagnosis, overtreatment, psychological distress due to false positive test results, false reassurance due to false negative test results, injury from invasive follow up tests, continuation of harmful health behaviors due to negative test results, and adverse psychosocial effects of being labeled as having a particular condition (being hypertensive for example). In addition, organized general check-ups take money and energy away from other opportunities to improve healthcare.

This study combined all the relevant studies that looked at how general check-ups, in the absence of symptoms, affected illness and death. It found that there was no benefit on risks of dying in general or dying with cancer or dying with heart disease or stroke in particular. In other words, those who had general check-ups died at the same rate as those who did not have general check-ups. These health check-ups did lead to more diagnoses and more medical treatment for high blood pressure with no improvement on death or illness. Thus this could be considered harms rather than benefits.

There are a couple of provisos regarding these studies. First is that people who accept an invitation to a check-up are different than those who do not. They tend to have a higher socio-economic status, lower cardiovascular risk, and lower mortality. Thus check-ups may not reach those who could benefit the most from them. Second is that physicians already screen those who are at higher risk for cancer and heart disease when they see these patients for other reasons, thus culling out those “high-risk” people from the general population and eroding any benefit from general screening.

The take-away point from the article is that more studies need to be done to see if there are benefits to doing general check-ups in asymptomatic people and that physicians should not stop doing targeted testing and preventive activities in those people who they feel may be at high risk.

Dr. Pisarik from Owasso Family Medicine feels that until more studies are done, people should still see their doctor and get preventive checks according to the United States Preventive Services Task Force recommendations that are referenced at the following web site: http://epss.ahrq.gov/ePSS/GetResults.do?method=search&new=true.

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Paul Pisarik

Paul Pisarik
Owasso Family Medicine
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