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Comment by pkaye | Hacker News Reader

> There is no real medical need for an ‘annual physical’ it is a creation of the American medical-industrial complex and creates more problems than it solves.

What problems does it create? Isn't preventive care a good thing? Also Japan does annual physicals much more rigorous that in the US. I wish what is done in the US was more rigorous because it would have caught the autoimmune disease that caused my kidney failure. Unfortunately by the time there are visible symptoms, the damage cannot be reversed.

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Medicine can hurt as well as heal. A concrete example. Many doctors will advise you not to get a full body MRI scan. You can pretty easily buy such a service, and hire some radiologists to pour over every cubic millimetre of your body. But it's a really bad idea.

Because they will almost certainly find something ambiguous or troubling. And they're gonna biopsy. And then, well, maybe that's ambiguous. Another biopsy. You're terrified, the doctor's now worried about something they would never have known about otherwise, and maybe you have surgery to get it early. In the end the complications of all that quite potentially add up to a shorter life expectancy than simply not getting scanned in the first place. On average. Though of course, if you had a giant treatable tumour that shows up, well, you'd want the scan. But most people don't have one, and all those interventions can cause harm.

There are a couple of orders of magnitude difference between findings from a full-body MRI and a routine labwork run.

The correct takeaway is to use information responsibly, not to deny yourself information.

I agree in principle, but health literacy is so appallingly low - globally - that more often than not people are not equipped to deal with this information. As I said in an earlier post on this thread, look at the askdocs subreddit. 90% of the posts there are worried well asking for clarification of some unnecessary test they went and specifically asked a doctor for, the result of which they don’t understand and which is causing a cascade of health anxiety.

If every person understood enough to realise how many ‘abnormalities’ enough investigations would show up, and how in 99% of people they mean absolutely nothing, then it would be fine. But that’s not our current situation. And if you’re one of those people who are capable of parsing the dense health literature and understanding the implications (or not) of ‘normal abnormal’ findings, then go for it. But for the population as a whole? It’s not viable or helpful

You can't do that unless you know the prior probability of everything you're looking for.

People are too dumb to do that, even if they're actively trying to.

Preventative care is different from the concept of all round comprehensive annual physical as it has been propagated through the culture from the American experience (I practice in Australia, so am talking from what I see from time working there, and the trickle through effect culturally of Australians thinking this is something they ‘have’ to have).

Preventative care consists of positive health messages (smoking cessation, moderate alcohol consumption, healthy diet, exercise), early identification of at risk individuals through family history, obesity, and then population wide cancer screening. Preventative care does not mean take a dozen tubes of blood and a pot of urine on every person every year.

I’m really sorry to hear about your kidney failure

Annual checkups are just that. 1) Body weight measurements. 2) The doctor talking to you about whether you have any medical or life concerns. 3) The doctor sharing advice on diet improvements, smoking improvements, exercise plans, including providing resources for them. 4) Recommended screenings based on age. 5) 1-2 vials of blood to get basic health information such as glucose levels, vitamin levels, etc. 6) Urine samples are only required if you're sexually active with multiple partners to screen for STDs and is completely optional.

That's been my experience. Through the annual physical I've been able to handle several minor issues, which have materially improved my life, and identified a major diagnosis that goes undiagnosed in the majority of people throughout their lives, and leads to them living significantly worse lives than they would have otherwise. By identifying it early, I have a chance for a much better lifestyle, and reducing the odds of an early death greatly.

Let me be really clear, everyone should have a doctor. But the concept of an annual checkup, as though there is a process to it and if you haven’t been to the doctor in the last 12 months is something you have to go through, is not part of general medical care. For the average under 30, and even under 40 male, with no family history, you are literally just pissing money away ordering annual vitamin, hormone and at some level lipid levels (although occasional checks are definitely useful).

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