Traditional Medicare pays for only one comprehensive physical examination, which must be done within six months of becoming eligible for Medicare at age 65. After that, you must have a clear medical indication in order to see a physician. An exception is the Medicare Advantage Program offered by insurance companies that, in addition to guaranteeing all Medicare benefits, is required to include annual physicals that emphasize health promotion and disease prevention.

While most insurance policies offer an annual physical, most are inadequate and involve minimal physician contact. For those who can afford it, an alternative, the so-called "executive physical," seems appealing.

Today, hospitals and health-care providers across the nation are marketing "executive physicals" — from the destination medical services of the Mayo Clinic and the Cleveland Clinic to many university and community hospitals. Despite their popularity, the "executive physical" may not be the best approach to health promotion.

In a paper published in the New England Journal of Medicine, Dr. Brian Rank seriously questions the value of this very expensive program. At a cost ranging from $3,000 to $10,000, he suggests, the perceived value of this intensive approach is based on the belief that if a little is good, more must be better. And the higher the price, the more valuable the program must be.

Originally intended to help corporations ensure the health of their executives, the "executive physical" is a comprehensive examination that can last one or two days and includes evaluation by multiple physicians, stress tests and CAT scans, with a focus on identifying disease. At the end, an analysis of overall health is given in a very detailed report. In most cases, the patient is sent away with a varying list of concerns and an appointment to return the next year.

First, extensive screening in an otherwise healthy individual is of no proven value. A good example is the oft-used total body CAT scan, which provides a dangerous amount of irradiation that may identify insignificant problems that lead to more tests. Sometimes a cyst or mass is seen in the lung, kidney or liver. Is it benign or could it be a cancer? A biopsy might be done, using a CAT scan-guided needle that provides more irradiation and a risk of serious bleeding, only to identify a lesion that is of no clinical significance.

In addition, Rank points out that being seen by multiple physicians and conducting tests for which there is no scientific evidence of benefit is totally inappropriate, inordinately expensive and even dangerous. His view, with which I wholeheartedly agree, is that: "Our goal should be to limit tests to those warranted by medical evidence to improve health, lengthen life and do more good than harm. The 'executive physical' seeks, by its very structure, to broaden testing, under the false assumption that more is better."

So what should we do? We need to rethink how, when and why we conduct an annual physical. First and foremost, the annual physical should not be just a mechanism to identify disease; it should provide patients an outlet to make healthier choices.

The evaluation by a physician should last a minimum of 40 minutes and include a comprehensive questionnaire, a detailed history and a thorough physical examination (which should be made more efficient with the results from the questionnaire and family history). Screening tests for cancers, heart disease, high blood pressure, diabetes and other illnesses should include only those recommended by the U.S. Preventive Services Task Force. It is equally important that an annual physical include a comprehensive nutritional, physical and lifestyle assessment. Dietitians, exercise physiologists and other lifestyle specialists should help develop a comprehensive program for the specific needs of each individual.

Between ages 50-65, a detailed physical should be performed every two or three years, or more frequently if a serious risk factor is present. And from age 65 on, this evaluation should be annual.

The health-care community has a responsibility to create an empowered and educated patient who truly knows how to navigate our complicated health-care system. With a new approach, the annual physical could be the perfect avenue to assure a better, longer and more independent life for all of us.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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