My doctor charges $125 for my annual checkup. I have no health problems. Does she have to charge this fee or is it at her discretion? Is this even legal in British Columbia?
The value of the annual physical has sparked considerable debate in the medical community. It seems silly to test reflexes and listen to chests of healthy patients. But without one, some argue, those at risk for cancer and other diseases may be missed.
"There is no good evidence that a screening annual health examination improves people's health," said Danielle Martin, board chair of Canadian Doctors for Medicare, and a family physician at Women's College Hospital in Toronto. "Most engage in this practice but there's no medical evidence to support it."
Still, she does see some value in it. They are a good way to remind patients they require a mammogram or to test for blood glucose – something that is difficult during a shorter appointment. Having a physical every year, however, may be overdoing it.
Annual physicals on patients with no symptoms are covered in Alberta, Manitoba, Saskatchewan, Quebec, Prince Edward Island, Ontario and the Northwest Territories. Nunavut funds them for kids under 10 and adults 65 and older; the Yukon pays for a "well-woman" checkup (which typically includes a pap smear and breast exam). New Brunswick, Newfoundland and Nova Scotia do not cover them in symptomless patients.
In British Columbia, unless the doctor has a reason for doing the examination, it's not considered medically necessary, according to Ryan Jabs, the B.C. health ministry spokesman, who says it's been that way for a long time. So yes, it is legal for your doctor to bill you for the physical. If she didn't bill you for the service, she wouldn't be paid.
I do see why governments would want to scrap the annual physical – it costs boatloads of money and does not deliver measurable health benefits. Doctors in Ontario are paid $77.20 for the visit, which typically lasts about 25 minutes.
"It's outdated to have a review of every system of the body," said Cleo Mavriplis, an assistant professor of family medicine at University of Ottawa. "Examining someone when they are healthy is very low yield."
Young, healthy men, she pointed out, need blood-pressure checks and preventive counselling for sexually transmitted diseases – but not every year. Young women require pap smears; those in childbearing years require counselling to take folic acid.
Replacing the annual physical with a preventive health exam makes a lot of sense. Such an exam, done every year or two in older patients – less in younger patients – could catch those who require screening, including mammograms, cholesterol and colonoscopies.
It would also give doctors a chance to counsel patients on exercise and healthy eating, instead of performing useless exams on healthy bodies.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.