Are annual check-ups still a thing? It depends | Canada Voices

Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.

Each week in my practice, I receive several requests from patients asking for a routine annual check-up. Here’s the surprising truth for healthy adults: Having a yearly full physical exam isn’t supported by the evidence. As a result, Canadian guidelines and several provinces no longer recommend it.

Although this shift has been occurring over the past several years, many people are still unclear about the reasons why. Here are some things to keep in mind before scheduling your next doctor’s appointment.

If you’re a healthy adult, annual check-ups won’t make you healthier

Choosing Wisely Canada, a clinician-led campaign launched in 2014 to reduce unnecessary medical tests and treatments, says an annual physical for healthy adults without symptoms or chronic conditions doesn’t improve health outcomes.

Large systematic reviews have found no reduction in deaths or serious illness among people who had routine annual physicals compared to those who didn’t. The Canadian Task Force on Preventive Health Care recommends periodic preventive health checks rather than annual physicals.

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This doesn’t mean you shouldn’t see your primary care clinician – whether a doctor or registered nurse practitioner – if you are feeling sick or have a specific health concern. It means the focus of care should shift from general health checks to targeted prevention and screening based on your age, risk factors and health conditions. This individualized approach allows for personalized care rather than a one-size-fits-all annual physical.

Good primary care should happen year round

One of the strongest arguments against routine annual check-ups is that good primary care doesn’t depend on a fixed date in the calendar. When I see a patient for something like a blood pressure check or back strain, I also take the opportunity to look at their chart and see if they’re due for other preventive care such as a mammogram or a tetanus booster. This approach to “opportunistic preventive care” allows access to timely care while avoiding unnecessary visits.

Routine annual check-ups take time out of family doctors’ schedules and can limit access to care for those who need medical attention. This is especially relevant in our health care system where approximately six million Canadians do not have regular access to a primary care clinician.

The shift away from the traditional annual check-up isn’t about withholding care, it’s about focusing on the right care at the right time.

Some people still need regular check-ins

While annual check-ups are no longer recommended for healthy adults, some people – including older adults, individuals on multiple medications or those with complex health needs, do require more frequent visits.

In addition to these groups, you should consider regular check-ins with your primary care clinician if you:

• Have a medical condition that needs regular monitoring. For example, patients with well-controlled high blood pressure or diabetes usually need follow-up and monitoring every three to six months.
• Have a mental health condition. Depression, anxiety or other mental health concerns often require closer follow-up, especially around medication changes.
• Are living with cancer: Depending on the cancer type and stage, structured follow-ups with your primary care clinician in addition to your specialists are often needed for several years during and after treatment.

Make sure your routine shots and preventive screenings are up to date

It’s important for patients to ensure their routine immunizations and preventive screenings are up to date. For people without regular access to a primary care doctor, some walk-in clinics may be able to order routine screening tests.

Here are some common preventive screenings to ask about:

• Cancer screening: These tests may be done earlier and more frequently based on risk factors such as family history, but here are the general recommendations:
• Blood pressure: The Canadian Task Force on Preventive Health Care recommends screening for hypertension at all appropriate primary care visits starting at age 18.
• Blood sugar check: This screening for diabetes is recommended every three to five years after age 40, and earlier if there are risk factors
• Cholesterol: The Canadian Cardiovascular Society recommends screening starting at age 40, or earlier if there are risk factors
• Osteoporosis: A bone density screening is generally recommended for people age 65 or older, or earlier if there are risk factors
• Immunizations: In addition to the annual flu shot and COVID-19 vaccine, there are several other adult vaccines to know about such as shingles and pneumococcal

The bottom line

All patients should stay connected with their clinician, keep track of when they’re due for screenings and immunizations, and take advantage of opportunities to review their health during visits.

Consider asking your primary care clinician these questions at your next visit:

• Am I due for any screening tests?
• How often should I come back?
• What vaccines do I need?

Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.