 Physicians and patients have come to expect the annual checkup as a routine part of care. However, considerable research has not demonstrated it has any substantial benefits, and so a revolt is brewing against the tradition of periodic checkups. Even the Society for General Internal Medicine has advised primary care physicians to avoid such routine general health checks for asymptomatic adults. Checkups seem to make sense, because historically medical practice has included all sorts of things that seemed to make sense, such as hormone replacement therapy for menopause, until it was put to the test and found to increase the risk of breast cancer, blood clots, heart disease, and stroke. Or like when doctors killed babies by making the so-called common-sense recommendation that infants sleep on their tummies, whereas we all know now face-up to wake up. We should always demand evidence. We check our cars regularly, though, so why shouldn't we also check our bodies? Well, unlike cars, our bodies have self-healing properties. To see if the benefits outweigh the harms, researchers decided to put it to the test. So what are the benefits and harms of general health checks for adult populations? The bottom line is that checkups were not associated with lower rates of mortality, meaning not associated with living longer or lower risk of dying from heart disease, stroke, or cancer. So general checkups may not reduce disease rates or death rates, but they do increase the number of new diagnoses. And the harmful effects of the tests and subsequent treatments could have balanced out any benefits. Possible harms from checkups include overdiagnosis, over-treatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, possible continuation of adverse health behaviors due to negative test results, adverse psychosocial effects due to labeling and difficulties with getting insurance now that you have a pre-existing condition, not to mention all the associated costs. For example, diabetes. Wouldn't it be great if we picked up a case of diabetes earlier? Perhaps not if they were given the number one diabetes drug at the time, Avandia, which was pulled off the market because instead of helping people, it appeared to be killing people. Adverse drug events are now one of our leading causes of death. When it comes to lifestyle diseases like type 2 diabetes, maybe we should instead focus on creating healthier food environments, like my new favorite organization, Balanced, to help prevent the diabetes epidemic in the first place. How many times have you tried to inform someone about healthy eating, about evidence-based nutrition, only to have them come back and say, no, I don't have to worry, my doctor says I'm okay. I've just had a check-up, everything's normal, as if like having a normal cholesterol is okay in a society where it's normal to drop dead of a heart attack to the number one killer of men and women. I mean, if you went to see a lifestyle medicine doctor who spent the check-up giving you the tools to prevent 80% of chronic disease, that's one thing, but given the way medicine is currently practiced, it's no wonder perhaps why the history of routine check-ups has been one of glorious failure. But generations of well-meaning clinicians just don't want to believe it. Policy should be based on evidence, though. Poor diet is on par with cigarette smoking, it's the most common actual cause of death, yet the medical profession is inadequately trained in nutrition. Worse, nutrition education in medical school appears to be in decline, if you can believe it, a shrinking of nutrition education among health professionals. So the advice you get in your annual check-up may just be from whatever last tabloid your doctor skimmed in the checkout line. Screening opportunities should not be regarded as a form of health education, when medical journal editorial read, people who are obese know very well that they are, and we have no means of helping them, and we should just shut up. Well, if you really have nothing to say that will help them, maybe you should shut up, especially doctors who say they have no idea what constitutes a healthy diet, though veggies and nuts are a good start. 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 check-ups 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 guideline 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, even reflexes, 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 should spend some of the time saved by telling the 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. This Cleveland Clinic dog shared a story about his own father who went in for a checkup. 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? A-order 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. Ten 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 $100 or so, but just think of all that downstream revenue for the hospice and all the specialists. Overdiagnosis is big business. Yes, too many patients bear the costs and harms of unneeded tests and procedures, but without annual checkups, 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 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.