 The model of getting an annual physical exam dates back nearly a century in American medicine, but recently many health authorities have all agreed that routine annual checkups for healthy adults should be abandoned. Yet the majority of the public still expects not only a comprehensive annual physical exam, but extensive routine blood testing. Given the gap between patients' enthusiasm and the new guidelines' skepticism about annual physicals, what are physicians to do? Well, first, we must educate patients about preventive practices of proven versus unproven benefit. For example, the only routine blood test currently recommended by the USPSTF, the official Preventive Medicine Guideline Setting Body, is cholesterol. The reason why so many physicians continue to perform annual examinations of patients' hearts, lungs, abdomen, and even reflexes and continue to order some of those tests that have been proven ineffectual or even harmful, is because otherwise the patient might leave unsatisfied with the visit. Evidence suggests that the more physical and laboratory examinations they perform, the better patients feel, so they're like placebo maneuvers. But rather than performing unnecessary or worse exams and tests, perhaps physicians suspend some of the time saved by telling their patients why they're not going to just go through the motions like some witch doctor. Most important, we need to educate ourselves about the dangers of overdiagnosis. There will always remain a small possibility that our exam might detect some silent, potentially deadly cancer or aneurysm or something. Unfortunately, for our patients, these serendipitous life-saving events are much less common than the false positive findings that lead to invasive and potentially life-threatening tests. His Cleveland Clinic dog shared a story about his own father who went in for a check-up. Can't hurt, right? The doctor thought he felt what might have been an aortic aneurysm, so ordered an abdominal ultrasound. Can't hurt, right? Aorta was fine, but something looked suspicious on his pancreas, so a CT scan was ordered. That can hurt, lots of radiation, but thankfully his pancreas looked fine. But hey, what's that on his liver? Oh, for goodness sake, looked like cancer, which made a certain amount of sense, having worked in the chemical industry, and so realizing how ineffective the treatments were for liver cancer, he realized he was going to die. The daughter was not ready to give up on him, though convinced him to see a specialist. Maybe if they could cut it out, he could live at least a few more years, but first they had to do a biopsy, and the good news was no cancer. The bad news, though, it was a benign mass of blood vessels, and so when they stuck a needle in it, he almost bled to death. 10 units of blood is like all you have. Pain, and so morphine, and so urinary retention, and so catheter, yet thankfully no infection. Just a bill for $50,000. The frustrating thing is that the whole horrible sequence wasn't like malpractice or everything. Every step logically led to the next. The only way to have prevented this life-threatening outcome would have been to dispense with that initial physical exam, the one that couldn't hurt, right? Well, why then? Do we continue to examine healthy patients? First of all, it's because we get paid to do it. His dad's initial doc only got, you know, $100 or so, but just think of all that downstream revenue for the hospice and all of the specialists. Overdiagnosis is big business. Yes, too many patients bear the costs and harms of unneeded tests and procedures, but without annual check-ups, doctors would miss out on all those opportunities for open communication and interpersonal continuity, to which one physician replied, look, if you've deluded yourself into thinking you're doing more good than harm, if you want to communication, why not just take your patients out to lunch or something? Of course, such lunches should fairly and ethically be preceded by an informed consent discussion that allows prospective diners to understand the risk that they may be patronized to and may well receive unnecessary and injurious interventions as a consequence of that grilled cheese and soup, particularly I would add, if you're feeding your patients grilled cheese having already chalked up your first such unnecessary and injurious act.