This is a question that comes up periodically.  I was reviewing a patient’s file recently and noticed that we hadn’t seen this adolescent in a few years.  When we recommended that he come in for a routine “physical”, the family told us he had been getting his done at school, so there was no need.

Understandable, but perhaps unsurprisingly, we have a different point of view, and I thought it might be worthwhile to explain.  First, though, let’s ask: What is a “physical” and why get one in the first place?  A “physical” (or a “check-up”) is shorthand for a visit focused on preventative medicine and anticipatory guidance.  Typically, we monitor a patient’s growth and their overall health.  We review diet and exercise, follow-up on previous health concerns, and address any other problems that have come up in the intervening year.  This is the time when we review vaccine status, and go over any recommended screening evaluations relevant to a patient’s age or history.

When we only see patients for ill visits, these important, but non-urgent, concerns can end up on the back burner for way too long.  Also, seeing patients when they are well helps us take care of them when they are not.  It establishes a frame of reference for when children are “just not themselves” and builds the kind of trust that becomes essential when we are trying to support and guide families through a stressful illness.

And yes, we do complete school forms, camp forms, and sports forms based on these visits.  However, while these forms are often the reason patients make an appointment to see us, merely getting them completed will not address the real reasons we recommend annual check-ups for growing children.  This is not a criticism of the professionals who do this work.  The basic format of an in-school exam or medi-quick visit really makes it impossible to do a good job with the preventative medicine elements.  In truth, without a prior relationship or at least a medical record to review, these practitioners must rely almost exclusively on patients to report any past events that might bear on sports participation.  Sometimes patients don’t recall the relevant details of a fainting episode that occurred two years ago, or the fact that the orthopedist wanted them to come back before playing soccer again.  Without knowing what to look for, a physical exam may be of limited value even when it comes to safely clearing an athlete to play.  Keep in mind, too, that athletes can be highly motivated to make these exams as unremarkable as possible.  Often, key points will only be found in the patient’s history.

Obviously, coming to your primary care doctor is not always the most convenient option and busy families must always prioritize.  But we strongly believe that the continuity with patients over time is an invaluable asset and, if at all possible, it should not be put aside lightly.  As we come into that busy summer season, where seemingly everyone needs a form filled out at exactly the same time, I hope we can convince you that, just once a year, it is well worth the effort to make that appointment.  With enough advance notice, we can make every effort to accommodate your scheduling needs.