Should a Healthy Adult Have a Physical Examination Every Year?

Scientific basis: The NEJM Clinical Decisions debate dated 3 September 2026, systematic reviews, and preventive health recommendations.

Should someone who appears healthy be examined?

A person visits a physician for an annual checkup. They have no complaints. Blood pressure, pulse, and oxygen level have been measured; age-appropriate cancer screening and vaccinations are up to date. Does such a patient need heart and lung auscultation, an abdominal examination, and systematic assessment of the lymph nodes, skin, thyroid, and circulation?

At first glance, the question seems easy. In medical culture, the belief that “a good doctor examines their patient” is very strong. Patients, too, often feel that a consultation ending without use of a stethoscope is incomplete. However, in an asymptomatic person with a very low likelihood of disease, an uncertain sound, a small asymmetry, or a harmless lump may initiate a chain of anxiety, repeat examinations, imaging, biopsies, and sometimes unnecessary treatments.

This article takes as its starting point the Clinical Decisions article in The New England Journal of Medicine that addresses this tension through two opposing viewpoints, titled “Physical Examination for Asymptomatic Adults.” The NEJM text is not a clinical trial, meta-analysis, or guideline. It is an academic debate consisting of positions that the editors assigned to two experts to defend; the journal does not officially declare either option correct.

In our view, this debate is valuable, but it also shows that healthy living cannot be reduced to “should we perform an examination or not?” Feeling well does not mean that risks that have not yet produced symptoms, loss of function, unhealthy habits, or psychosocial burdens are absent. Likewise, undergoing numerous examinations, blood tests, and imaging studies does not guarantee that health has been assessed comprehensively.

Our approach to a person who appears healthy therefore does not start with a standardized, preprepared checkup list. It begins with learning about the person, their lifestyle, and their risks in detail, and then putting that information into clinical context through an internal medicine assessment. The scope of the physical examination, laboratory tests, imaging, cancer screening, and specialty assessments are selected for the individual after these stages.

In the first sections of this article, we will examine both sides of the NEJM debate and the scientific evidence. Later, we will answer the question from the perspective of our own practice and explain, within Check the Life by Prof. Dr. Mustafa Özdoğan Healthy Living, Chronic Disease Prevention and Early Diagnosis Clinic , why we assess health in five dimensions and how we would evaluate the 60-year-old person in the NEJM case.

What was the NEJM case?

In the example, a 60-year-old man with no known chronic disease returns for a family medicine visit after an interval of several years. He feels well. He does not smoke and consumes two to three alcoholic drinks a week. His blood pressure is 126/88 mmHg, pulse is 72 beats per minute, and oxygen saturation on room air is 98%. His age-appropriate cancer screening and vaccinations are up to date. The physician has decided to request some blood tests. The sole question under discussion is whether to perform a routine comprehensive physical examination.

Do comprehensive health checkups prolong life?

The broadest answer comes from studies examining “general health checkup” packages rather than individual examination maneuvers. Alongside a physical examination, these packages may include laboratory tests, risk assessment, and various screenings. Their findings therefore do not isolate the effect of examination with a stethoscope; they assess a broader package of healthcare services.

The 2019 Cochrane review included 17 randomized studies; 15 studies reported outcomes for a total of 251.891 people. General health checkups did not significantly reduce all-cause mortality, cancer mortality, or cardiovascular mortality. The main numerical findings are as follows:

A risk ratio of 1,00 means that there is no difference between the two groups. A confidence interval that includes 1 likewise means that a statistically reliable benefit was not demonstrated. These data do not support the conclusion that “seeing a doctor is of no benefit.” Some studies were conducted decades ago; people in the control groups also received healthcare when needed. Moreover, each modern, targeted screening program must be assessed on its own evidence.

A more recent review presents a more nuanced picture

A review published in JAMA in 2021 assessed 19 randomized studies and 13 controlled observational studies. General health checkups did not generally reduce mortality, cardiovascular events, or the incidence of cardiovascular disease. However, there was greater recognition of conditions such as hypertension and depression, modest improvement in blood pressure and cholesterol control, increased participation in cancer screening, and improvement in some patient-reported outcomes.

For example, in the South-East London study involving 7.229 people, mortality over eight years was 6% among those invited for a checkup and 5% among those not invited; no mortality benefit was demonstrated. By contrast, in a matched analysis of Medicare data, 69% of those attending an annual preventive health visit underwent colorectal cancer screening, compared with 60% of those not attending. The second finding is observational; people who attend such visits may differ in their health behaviors from the outset. Nevertheless, it shows that checkup visits can serve as a gateway to evidence-based services.

How does a false-positive finding arise?

When there are no symptoms, the probability of disease is very low. In a low-probability setting, a “positive” examination finding with limited specificity and accuracy sometimes increases the probability of disease far less than we imagine. This is the clinical application of Bayes’ principle: a finding cannot be interpreted independently of the pre-examination probability.

The NEJM article uses lung crackles as an example. The highest reported positive likelihood ratio for predicting pulmonary infiltration in a patient with an acute cough is 2,7. If a baseline probability of 0,1% is assumed in an entirely healthy person, the probability after the same finding is approximately 0,27%.

This finding may lead to a chest radiograph or CT scan; an uncertain shadow there may lead to further imaging and sometimes invasive procedures. At every step in the chain, there is a possibility of detecting real disease, but also radiation, complications, cost, lost time, and anxiety. The assumption that “looking more is always safer” is therefore incorrect.

The difficult-to-measure benefit of examination: trust and contact

The argument in favor of examination is not based solely on detecting disease. People expect their physicians to listen carefully, approach their bodies respectfully, and assess the area that concerns them. In a study involving 452 healthy people, those who rated their physician more positively recalled an average of 8,20 examination maneuvers, whereas those giving lower ratings recalled 4,44 maneuvers.

This association is not evidence of causation. More attentive physicians may have communicated better as well as performing more examinations; satisfied patients may also have recalled the examination more readily. Although a 2024 meta-analysis of touch interventions reported physical and psychological benefits, it included very different interventions such as massage, hugging, and therapeutic touch. This finding does not establish that routine heart and lung examination improves disease outcomes.

Nevertheless, the clinical relationship has real value. The problem is equating trust solely with “how many parts of the body were touched.” If the physician explains why particular examinations are performed and why some are not considered necessary, trust can be established without a ritual performed for show. Examination must always be accompanied by explanation, consent, privacy, and a chaperone when appropriate; it should also be remembered that unwanted contact can reduce trust.

A preventive health visit and a head-to-toe examination are not the same thing

This is the crucial distinction. Preventive healthcare includes updating medical and family history, reviewing medications, smoking and alcohol use, nutrition and activity, sleep and mental health, vaccination, fall risk, and age-appropriate screening. Most of these are assessed through discussion, measurement, laboratory testing, or a specific screening test.

For example, blood pressure measurement in asymptomatic adults is recommended on strong evidence. An initial elevated office reading should be confirmed through home measurement or 24-hour ambulatory monitoring before medication is started. We discuss what pulse, respiration, temperature, and oxygen levels tell us in detail in our guide to vital signs .

Cancer screening does not work on the premise that “the doctor examined me by hand, so there is no cancer.” Breast, cervical, colorectal, and, in the appropriate risk group, lung screening are performed using specific methods and intervals. Our article on current cancer screening programs brings these tests together. The population-level contribution of screening and prevention for the five most common cancers is also examined in our assessment of the benefits of early-detection screening .

However, broad packages that look for every possible disease in healthy people do not share the same level of evidence. As more parameters are measured, the probability of finding at least one “abnormal” result increases. A similar issue applies to new technologies such as multicancer tests: detecting an early signal does not, by itself, establish that a test reduces mortality. We explain this evidentiary threshold in our article on multicancer early-detection tests .

What can form the foundation of a preventive health visit?

Procedures that may cause more harm than benefit if performed automatically every year

Ordering an annual ECG, chest radiograph, abdominal ultrasound, broad tumor marker panel, or numerous hormone and vitamin tests in the same package for everyone without symptoms or specific risk is not an evidence-based approach. When one result is borderline, a “let’s check again” cycle can begin. If a test’s purpose and the steps to take after a positive result have not been defined in advance, ordering it is not a good screening program.

Population screening for asymptomatic carotid stenosis is not recommended; looking for a neck bruit and then performing ultrasound is not an automatic route to safety either. Routine rectal examination does not replace prostate cancer screening. Routine pelvic or testicular examination in asymptomatic people at average risk also has its own evidence and balance of harms. These organs are, of course, examined when there are symptoms, a mass, pain, bleeding, or high risk.

The aim here is not a competition to reduce examination. It is to connect every maneuver to a clinical question. If there are no answers to “what is this examination looking for, what will we do if we find it, and what is the probability that the finding is false?”, the procedure may simply perpetuate a habit.

Who needs a broader examination, and who needs a more selective one?

Initial consultation or a long interval: A patient not having seen a physician for years, the absence of previous measurements, and the establishment of a new treatment relationship may make a broader baseline examination reasonable. It should not be presented with a claim that it will “find every hidden disease.”

Known chronic disease: Someone with heart failure, COPD, diabetes, liver disease, or a neurological condition is not an asymptomatic adult at average risk. Assessment of edema, respiration, circulation, the feet, and neurological status may directly affect treatment decisions.

Older age: In an older person, gait speed, balance, orthostatic blood pressure, vision and hearing, cognition, nutrition, and daily-life functioning may provide more information for decisions than ritual examination of every organ. Comprehensive geriatric assessment is not the same subject as the average-risk “healthy adult examination” discussed in NEJM.

A cancer diagnosis or history of cancer: A person receiving active treatment, being monitored for treatment toxicity, or undergoing follow-up for recurrence is also outside this debate’s target population. Lymph node, skin, and neurological examination, organ findings specific to treatment, and performance assessment may form part of oncology follow-up. The frequency of physical examination in a patient with cancer is planned according to tumor type, stage, treatment, and symptoms.

A new or changing symptom: A person with chest pain, breathlessness, unexplained weight loss, bleeding, a palpable mass, loss of strength, or a new skin lesion is no longer “asymptomatic.” The debate about routine screening cannot be used to delay diagnostic examination and investigation in such a patient.

What would we do in the NEJM case of the 60-year-old?

If required to choose one of the two options, for this person who has been away from healthcare for several years and is being assessed for the first time, we would consider a thoughtfully planned baseline examination necessary. We would plan it as an assessment based on the patient’s concerns, lifestyle, history, age, and risks, rather than as an annual ritual that examines every organ in the same sequence.

In the Check the Life model, assessment begins before entering the examination room

The service we opened at Memorial Göztepe Hospital, Check the Life by Prof. Dr. Mustafa Özdoğan Healthy Living, Chronic Disease Prevention and Early Diagnosis Clinic is built on this approach. Before the outpatient consultation, the person comprehensively assesses their own health through the Check the Life app . Information such as nutrition, physical activity, sleep, habits, past medical history, medications, and family history is brought together in a single health profile.

Self-assessment in the app does not establish a diagnosis on its own. It makes risks the person has not noticed visible, sets the agenda for the clinical consultation, and shows the physician which areas require more time. At the clinic, the process begins with a consultation and physical examination by an internal medicine specialist . After the app data, medical history, and examination findings are assessed together, the necessary laboratory tests, imaging, cancer screening, and assessments by other specialties are selected.

Rather than applying a ready-made checkup package to everyone, this model tailors the health plan to the individual. Two people of the same age do not have to have the same test list: a strong family history, smoking, and inactivity may stand out in one, while loneliness, a sleep disorder, obesity, or previously unmonitored high blood pressure may take priority in the other. The genetic component does not mean that everyone undergoes a broad gene panel either; it begins with taking an accurate family history and proceeds to genetic counseling in those who need it.

In the Check the Life approach, we include at least one cardiology assessment for everyone after age 40 . If there is a family history of early heart disease, hypertension, diabetes, a cholesterol disorder, obesity, smoking, palpitations, symptoms on exertion, or another additional risk, this assessment may take place at an earlier age, and follow-up frequency is determined individually. A cardiology assessment likewise does not mean that everyone automatically receives the same imaging package; the cardiologist selects the necessary tests based on history, examination, and overall risk.

If the 60-year-old person in the NEJM case came to our clinic, we would first establish a five-dimensional health profile and then arrange a detailed assessment by an internal medicine specialist. We would repeat blood pressure measurement using the correct technique and consider weight and metabolic risk, heart, lung, and circulatory findings, medications, sleep and psychological state, nutrition, activity level, and family history together. The absence of regular healthcare for several years would provide an additional reason for a more comprehensive baseline assessment.

Because this person is 60 years old, we would also plan a cardiology assessment if it had not previously been performed or if the current clinical situation required it. Because the case states that cancer screening and vaccinations are up to date, we would not repeat them simply because the person attended a new center; we would verify the records and plan the next dates. We would relate lipid and glucose assessment to cardiometabolic risk and select other laboratory tests and imaging according to the questions raised by app data, history, and examination.

Instead of automatically repeating the same maneuvers and tests every year, we consider what has changed since the previous assessment. This is where Check the Life’s temporal dimension becomes valuable: changes in the direction of weight, activity, sleep, stress, social support, symptoms, and clinical measurements can determine the need for a new examination or test. The person is also given clear answers to “which risks did we assess today, why did we select these examinations and tests, and when is the next checkup?”

How can a patient prepare for a checkup appointment?

• Write down new, changing, or concerning symptoms with a brief timeline.
• List your prescription medicines, nonprescription painkillers, vitamins, and herbal products.
• Share newly learned family information, such as heart disease, stroke, or cancer at an early age.
• Bring the dates of your latest vaccinations, cancer screening, and previous abnormal tests.
• Ask, “What question does this examination or test answer, and what will we do if the result is abnormal?”
• If you do or do not want a particular area examined, say so clearly. Examination should take place with explanation and consent.

How might digital health and telemedicine change this balance?

Home blood pressure, pulse, and rhythm measurements, wearable devices, and video consultations are moving part of preventive healthcare outside the clinic. This development does not eliminate physical examination. It makes a good triage system that identifies who needs an in-person assessment more important.

A remote consultation can obtain a detailed history, plan screenings and vaccinations, and review home measurements. However, new breathlessness, neurological symptoms, a palpable mass, or a clinical change not explained by device data may require an in-person examination. A good health checkup of the future will be a system that reduces unnecessary alerts and directs the right person to physical assessment at the right time, rather than one that makes the same number of measurements for everyone.

Drozdogan Academy commentary

The value of the NEJM debate lies in moving physical examination beyond the binary choice of “do it or don’t” and prompting us to question its purpose. In someone with symptoms, physical examination is an integral part of diagnostic reasoning. In known disease, it guides treatment and follow-up decisions. In a healthy person at low risk, however, the same examination may become screening without a clear target.

Good medical practice is more than a longer examination checklist. Listening to the patient, estimating risk accurately, providing evidence-based screening on time, avoiding unnecessary tests, and explaining uncertainty openly when it arises are parts of the same whole. Contact with the patient’s body sometimes has diagnostic value and sometimes helps build trust; in either case, it must be purposeful, respectful, and consensual.

The most appropriate model for a healthy adult therefore cannot be based on either a head-to-toe examination for everyone every year or no examination for anyone . The right model is a selective approach that retains basic measurements, maintains evidence-based preventive services, and adjusts the scope of examination according to the individual’s history, risk, age, preferences, and previous findings.

Scientific sources

1. Nigam M, Goroll AH, Cifu AS. Physical Examination for Asymptomatic Adults. N Engl J Med. 2026;395:923-925.
2. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2019;1:CD009009.
3. Liss DT et al. General Health Checks in Adult Primary Care: A Review. JAMA. 2021;325:2294-2306.
4. Bloomfield HE, Wilt TJ. Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult. VA Evidence Synthesis Program; 2011.
5. Duan L, Mukherjee EM, Federman DG. The physical examination: patient preferences and expectations during primary care visits. Postgrad Med. 2020;132:102-108.
6. Packheiser J et al. A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions. Nat Hum Behav. 2024;8:1088-1107.
7. U.S. Preventive Services Task Force. Hypertension in Adults: Screening. 2021.
8. U.S. Preventive Services Task Force. Asymptomatic Carotid Artery Stenosis: Screening. 2021.
9. U.S. Preventive Services Task Force. Skin Cancer: Screening. 2023.

This content discusses preventive health visits for asymptomatic adults at average risk. Examination and testing plans differ when there are new symptoms, known disease, pregnancy, frailty in older age, cancer treatment, or an individual’s specific high risk.