A recent article in The New York Times questioned the usefulness of the adult annual physical exam, with its unnecessary examinations and tests. It prompted me to give some thought to the idea of an outpatient world without the prized annual well visit.
While I agree that many times unnecessary tests and examinations are performed out of habit instead of proven benefit, I still believe the annual exam is an important opportunity for the primary care provider to maintain contact with his or her patient panel. It also provides an opportunity to bring less-than-obvious health concerns into the light. Discussions about family life and work stressors might reveal, for example, underlying depression, anxiety or infertility issue that would have never been addressed otherwise.
Maybe the annual exam simply needs a makeover. As a physician assistant in training, I was taught that most of our diagnoses would be developed via a thorough history, and the physical examination and ancillary testing would confirm our hypotheses. So what if, in the interest of developing and maintaining the all-important medical history, patients could schedule their annual as 15-minute online visit, via audio chat and webcam?
This kind of visit would necessarily emphasize prevention and education, since patients and providers would be forced to use words instead of procedures and exams. Providers would be forced to listen carefully to their patients, and patients could feel at ease in their own homes. And maybe more patients would schedule this type of visit, finding it less invasive—no probing and prodding required.
Who would pay for these visits? Ideally, insurance companies would see the value in a truly preventive and therapeutic relationship between patient and provider. The stronger the bond patients feel with their PCP, the more likely they are to follow up with advice regarding mammograms, PAP smears and colonoscopies. They may also be less likely to visit the emergency room for non-emergent issues.
Many patient portals already provide e-mail access and patient education in the interest of open communication. With the advent of health information technology, secure online visits via webcam are not just a thing of the future; they are here and now. And they are an enormous opportunity to build partnerships between patients and providers, and thus promote patient engagement. Providers need to know their options and get on board.