The American Medical Association (AMA) began advocating a comprehensive annual physical exam in the 1920s. For many years, this exam was quite simple and straightforward; it consisted of the doctor inquiring about any recent health changes, pounding on the chest and listening to the heart, checking reflexes, and obtaining a few laboratory tests.

With the current availability of new measurements and medical technologies, today's comprehensive check-up has expanded to include an extensive (and costly) battery of blood tests, electrocardiograms, x-rays, sonograms, and probably other procedures aimed at unearthing early stages of diseases like cancer. Yet, the need for such a comprehensive exam has remained controversial even among doctors.

Periodically, several groups have examined the content and value of annual examinations. In 1979, a Canadian task force concluded that a scheduled annual physical exam was not required and instead suggested that most preventive health care interventions could be carried out during office visits for other short-term or long-term problems. Since then, the AMA, American College of Physicians, the U.S. Preventive Services Task Force, and the U.S. Public Health Service have all agreed that a less rigid and more selective approach should replace the annual physical examination.

The findings of a comprehensive physical examination are unlikely to change within a year in a healthy man or woman, assuming, for example, that recent examinations of the heart and lungs, electrocardiogram, blood cell count, and tests of the thyroid, cholesterol and liver have all been normal.

Surveys show, however, that about two-thirds of patients expect an annual physical examination from their doctors. And approximately the same percentage of family doctors and general internists, who carry out the bulk of these annual physicals, believe they are a good idea. One study found that an annual examination was carried out in 20 percent of the whole patient population and in more than half of the patients over age 65.

I am in the minority, both as a patient and a doctor, because I don't believe that an annual physical examination is necessary. What healthy people of all ages truly need are reminders to follow preventive measures like getting the flu vaccine, stopping smoking, controlling weight, improving their diet and exercise routines, and getting screening tests of proven value, such as mammography, a Pap smear for cervical cancer, and a colonoscopy.

All of these issues could be discussed with most patients during their other visits to the doctor — one study, in fact, estimated that three-quarters of the patients who had an annual physical had been seen by their doctor within the previous year.

Those not seen within the prior year should be asked back by the doctors for a visit at some regular interval, perhaps each year — not for a comprehensive examination, but for a selective discussion of the preventive measures listed above and for early detection of the health problems for which each individual may be at higher risk.