Thread by @jeffreylinder

1/20 Tweetorial about our new JAMA paper!!

**Should you get a regular check-up?**
(“general health checks” in the paper)

From @davidtliss, @ToshiUchida, Cheryl Wilkes, @a_radakrishnan, and me.

jamanetwork.com/journals/jama/…

2/20 First, big debt of gratitude to @EbonyBoulware, @GailDaumit, @Neil_R_Powe, @ebcBass, @cochranecollab, @LasseKrogsboll, @PGtzsche1, @DyakovaMariana, and others…

…for doing earlier systematic reviews that got us started!

3/20 Now, some, including @ZekeEmanuel, have said “skip your annual physical.”

nytimes.com/2015/01/09/opi…

4/20 The @ABIMFoundation and @SocietyGIM through #ChoosingWisely, say “don’t routinely perform annual general health checks that include a comprehensive physical examination and lab testing.”

choosingwisely.org/clinician-list…

5/20 Some of these recommendations were based on those prior systematic reviews….

6/20 We took a wider look across RCTs and observational studies at a broader range of outcomes including:
- patient-reported outcomes
- health behaviors
- adverse effects

7/20 After an extensive search, we wound up with 32 studies in our review.

Studies had to be of adults, in primary care, with a comparison group, sample size > 200 patients, and not disease-specific.

8/20

Results:

Table 2 is A LOT!

4 pages long.

Includes all 32 studies, stratified by RCT vs. observational, reported mortality vs not.
jamanetwork.com/journals/jama/…

9/20 You’ll notice many studies are from Europe, older, have “low intensity” interventions – say, 1 or 2 health checks over years – and many have follow-up that is 5 years or less.

10/20 To cut to the chase, the @JAMA_current Editors had us summarize the main findings in handy Table 3…..

11/20 First, the bad news, there is not clear evidence that getting a regular check-up will help you live longer or avoid heart attacks or strokes.

12/20 However, some better news…
…check-ups are associated with increased chronic disease detection, risk factor control, and receipt of recommended preventive services.

***I’m looking at, you, high blood pressure!!**

13/20 Interestingly, check-ups are associated with improved “patient-reported outcomes.”
Increased feeling of well-being, QOL, self-rated health.
Decreased health worry, anxiety.

14/20 Of course, that brings up interesting questions about WHY people feel better for having had a check-up.
(If it is because they think they’re going to live longer, the good feeling might be misplaced. More on this in a later thread…)

15/20 We looked for adverse effects.
Unnecessary visits could lead to unnecessary testing and treatment and bad things.
The few studies that looked found a few things, but these were small, in subgroups, and need to be understood in context

(More in a later thread...).

16/20 So, bottom line. A checkup might not be proven to help you live longer, but it does help detect and control chronic disease, get recommended preventive services that have their own benefits, AND improves how you feel.
jamanetwork.com/journals/jama/…

17/20 Do you need an “annual physical?” No. It doesn’t have to be every year and there is very little in the “physical” that has been proven to be of benefit.

18/20 Also, “routine labs” are not a thing.
A prior thread on this…

19/20 So, if you’ve had regular check-ups and are up to date with preventive services an “annual” visit might not be of much proven benefit.

(More on this in a later thread...)

20/20 However, those who stand to benefit the most from a check-up are for those overdue for preventive services, have uncontrolled risk factors, low self-rated health, or poor connection to primary care.
jamanetwork.com/journals/jama/…