The annual check-up: what is worth doing

The annual physical is one of the most familiar rituals in healthcare and one of the least supported by outcome evidence, which is an uncomfortable combination.

What the evidence shows

Systematic reviews of general health checks in adults have found little effect on mortality from cardiovascular disease or cancer.

They do increase the number of diagnoses made and the number of treatments started, which sounds like a benefit and is not automatically one, since some of those diagnoses represent overdiagnosis.

Several professional bodies have moved away from recommending routine annual physicals for asymptomatic adults, in favour of targeted, risk-based prevention.

Which does not mean preventive care is worthless — it means that a general once-over is a less effective vehicle for it than a defined list of specific actions.

The components that do have evidence

The postcard version.

Blood pressure measurement, which is the highest-value single measurement in preventive medicine.

Cardiovascular risk assessment at the age recommended locally, incorporating lipids.

Diabetes screening for people with risk factors.

Attendance at national cancer screening programmes for which you are eligible.

Vaccination according to the adult schedule.

Smoking, alcohol and physical activity assessment with brief intervention, which have evidence at population level.

Weight and, where relevant, discussion of it.

Mental health screening, which is increasingly included and is frequently the most useful part.

Medication review for anyone on several drugs.

And for people with existing conditions, the specific monitoring that condition requires.

What is generally not worth doing routinely

In asymptomatic people without risk factors.

Broad blood panels ordered without a question, which reliably produce incidental abnormalities requiring follow-up.

Resting electrocardiograms in asymptomatic low-risk adults, which several guidelines recommend against.

Exercise stress testing without symptoms or risk factors.

Whole-body imaging, which has no evidence of benefit and a well-documented rate of incidental findings.

Tumour marker testing outside specific indications.

Vitamin and mineral panels in the absence of clinical suspicion.

And urinalysis in asymptomatic adults.

The cascade problem

Why untargeted testing is not neutral.

Reference ranges are constructed so that roughly one healthy person in twenty falls outside them for any given test.

Order thirty tests and an abnormality is close to guaranteed.

The abnormality prompts a repeat, then imaging, then a referral, then sometimes a biopsy — each step carrying cost, anxiety and a small physical risk.

Studies of incidental findings from imaging consistently show that the great majority are benign and that pursuing them produces net harm in many cases.

Which is why the useful question before any test is what will be done differently depending on the result.

Private health checks

The commercial version.

Executive health screening packages bundle exactly the tests above that guidelines advise against, at prices ranging from moderate to substantial.

They generate results without clinical context, and the follow-up burden falls on the person and on whatever health system they belong to.

Marketing frequently uses narrower optimal ranges than laboratory reference intervals, converting normal results into problems requiring a product or a repeat visit.

The honest assessment: for most healthy adults, the money buys reassurance in the short term and a meaningful chance of a new worry.

What actually changes outcomes

The things that are free or nearly so.

Not smoking, which remains the single largest modifiable factor.

Physical activity at guideline levels.

Blood pressure control.

Alcohol within lower-risk limits.

Dietary quality.

Vaccination.

Screening attendance.

Sleep.

And seeing someone promptly about symptoms rather than testing broadly in their absence.

Making a consultation useful

If you are going anyway.

Bring a specific list of concerns in priority order.

Bring a full medication list including anything over the counter.

Know your family history for cardiovascular disease, cancer and diabetes, which is one of the more useful things you can supply and which people rarely have to hand.

Ask what screening you are due and eligible for.

Ask what your cardiovascular risk is.

Ask whether any of your medications can be stopped.

And ask which symptoms should bring you back, which is the most valuable output of any appointment.

Where an annual review is genuinely indicated

Not everyone should be discouraged.

People with chronic conditions requiring monitoring — diabetes, hypertension, asthma, kidney disease, heart failure, thyroid disease — have condition-specific annual reviews with clear evidence behind them.

Older adults on multiple medications benefit from structured medication review.

People on medications requiring monitoring have defined schedules.

And anyone with symptoms should be seen at any time rather than waiting for an annual slot.

General information only, not medical advice. Consult a qualified clinician about which checks and screening apply to you.