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REPLY
Public Expectation for Annual Physical Examinations
Sylvia K. Oboler, MD;
Allan V. Prochazka, MD; and
Robert J. Anderson, MD
5 November 2002 | Volume 137 Issue 9 | Page 774
IN RESPONSE:
While we generally agree with the points made by Drs. Wool and Poplin, two issues deserve emphasis. First, as we and Laine (1) have noted, annual examinations may have value not only for providing preventive health services not furnished in daily practice but also for enhancing patient–provider relationships. Second, although strategies to enhance provision of appropriate medical services are becoming better defined (2), methods to discourage use of inappropriate services have received less attention. Complex personal, organizational, and market-level influences affect patient preferences and physician practices (3). It is our working hypothesis that a greater understanding of these influences could lead to an effective approach to limit inappropriate annual examinations. For example, a greater understanding of the complex influences underlying inappropriate antibiotic use for upper respiratory tract infections has resulted in effective strategies to limit such use (4).
Dr. Mukohara suggests that our survey may have overestimated public desire for an annual examination. Dr. Mukohara is correct that we did not give patients a choice as to whether they preferred a case-finding approach versus an annual approach for their preventive health services. However, since we explicitly asked each respondent to provide a yes or no answer about whether they felt the need for an annual checkup, we doubt that our results significantly overestimated public desire for such a checkup. Our study was not designed to address patient preference (case finding vs. annual examination) for provision of health services.
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Author and Article Information
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Denver Veterans Affairs Medical Center; Denver, CO 80220
University of Colorado Health Sciences Center; Denver, CO 80262
1. Laine C. The annual physical examination: needless ritual or necessary routine? [Editorial] Ann Intern Med. 2002;136:701-3. [PMID: 11992306].
2. Stone EG, Morton SC, Hulscher ME, Maglione MA, Roth EA, Grimshaw JM, et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis Ann Intern Med. 2002;136:641-51. [PMID: 11992299].
3. Landon BE, Reschovsky J, Reed M, Blumenthal D. Personal, organizational, and market level influences on physicians' practice patterns: results of a national survey of primary care physicians Med Care. 2001;39:889-905. [PMID: 11468507].
4. Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults JAMA. 1999;281:1512-9. [PMID: 10227321].
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