I am not a fan of “wellness” visits, those yearly exams that your insurance insists you should do even if you don’t have any medical problems. Evidence from randomized controlled trials suggests they don’t make any difference to people’s health, but they (obviously) contribute to the primary care physicians' workload.
Having said that, I recently reached a nice round number of years, so it was time to get my cholesterol checked and finally get a flu shot. I enjoyed the banter, but I could also see how and why there may be no health benefit. If annual exams are good for anything, it is to find chronic asymptomatic conditions that have long-term consequences — high blood pressure, high cholesterol and high glucose are the big ones at my age. Testing for them has the highest yield in a generally low-yield visit, so whoever is seeing you should get at least those three right.
After this morning I suspect most places are not doing it right. The person checking my blood pressure did not care at all about the correct technique: whether I still had my sleeves on when they placed the cuff, whether my feet were on the ground or hanging over the raised exam table, whether my legs were crossed, or whether I was talking while measurement was being taken. Worse yet, no one asked or cared whether I had anything to eat or drink before getting my blood drawn for the labs. I could have downed a sugar-and-cream-laden coffee with a Boston cream chaser minutes before the visit and no one would have known. This is the complete opposite of Serbia, where they drill into you at an early age that you must have nothing to eat or drink — water excepted — before getting your blood drawn for anything; which is an extreme of its own kind but one that at least doesn’t result in lab results that you can’t interpret.
At best the loose approach to testing leads to more labs having to be drawn if and when something comes back out of range and the doctor wonders why. At worst it leads to misdiagnosis (“Your cholesterol is through the roof, you’d better be on a statin!") or missed diagnosis (“Your cholesterol is a bit too high but you ate before the labs were drawn so it’s probably just from the food.") — neither is good.
Even when properly done, I don’t think the annual exams are worth it. There are plenty of reasons to see the physician for other things, and sneaking in a blood pressure check and some labs on top of those is easy enough without overburdening the system. For those fortunate enough to be without ailments, a visit every 5–10 years to make sure all the screenings are up to date sounds about right. The paradigm of treating your body as a car to be taken to the shop for scheduled maintenance is wrong: our bodies aren’t intelligently designed mechanisms with replaceable parts that wear out at a predictable rate, and we can’t be taken apart and put back together at a whim. The trend of renaming the annual exam to something else recognizes this reality.
The replacement term, wellness visit, is not much better. In theory it should make the doctor (or nurse practitioner) enhance the lives of people they are seeing by taking a more holistic approach: “You are not a patient, you are a person.” In practice, it turns doctors into box-checkers: are you suicidal (yes/no), do you drink alcohol (yes/no), do you use illicit drugs (yes/no). It takes time away from things doctors were trained for — to treat disease that can be treated, provide council about the diseases that can’t, and know the difference between the two — and makes them do things that are as important, maybe more so, but not in their area of expertise.
The problem isn’t unique to medicine. It’s good to have the police around to deal with murder and theft, not so much when there is a domestic dispute or an acute psychotic episode, now (holistically?) called “a mental health crisis”. They used to be matters for the extended family or neighbors to deal with, not an outside force. Wherever the two were lost, public and private services picked up some of the responsibilities; the doctors seem to have gotten the role of the friendly ear, listening to the issues that used to be mulled over a cup of tea, or — sure, I’ll go there — in the bowling alley. This is a job they were not trained to do and for which they receive no compensation, so in that sense it is fair: the (American) society got what it paid for.