During my career in pathology, there has been a constant litany of complaints from various quarters about excessive ordering of lab tests. And yet, all the while, a complete blood count (CBC) and other lab tests such as electrolytes, lipid panels, and renal panels have been routinely ordered as part of periodic physical exams as a means to screen for diseases that might not be recognized during the physical exam itself. However, the annual physical exam itself has been criticized by many as being unproductive (see: Is the Annual Physical Unnecessary?). The following arguments were marshaled in this article to underscore this point:
By the 1980s, doctors had begun to question which components of the annual physical were worthwhile. Little by little, practices changed. Annual CBCs, urinalyses, TB tine tests, and chest x-rays were found to be useless and were dropped. Pap smears and STD screening were proven worthwhile, but the routine pelvic exam with speculum and bimanual palpation was not. The physical examination of a healthy, asymptomatic adult is unlikely to reveal any significant abnormality (1) that would not have been detected eventually when symptoms developed and (2) whose earlier detection and treatment would reduce morbidity and mortality in the long run.
I will readily concede that a yearly physical may have minimal value in detecting diseases that might otherwise be detected early in a healthy asymptomatic adult. However, many of the routine lab tests ordered as a component of the yearly physical do serve a predictive function. I have blogged before about the use of big data, deep learning, and neural networks in support of predictive diagnostic analytics (see, for example: Should the Work Product of "Non-Explainable" Medical Algorithms Be Ignored; Identifying Patients for Remote Monitoring with Predictive Analytics). We may thus be entering an era when the annual physical exam can no longer be justified when the patient has no significant complaints but an annual lab screen (ALS) comprised of a panel of standard tests coupled with scrutiny by predictive analytic algorithms will constitute a more than adequate substitute.
Dr. Harvey Kaufman of Quest Diagnostics made the following comment about the potential value of big data and the evolving role of the clinical labs (see: Big Data Analytics in Healthcare – How Laboratories Can Play a Leading Role):
The increasing volume of data from a multitude of sources offers opportunities for improving healthcare. Dr. Kaufman believes clinical laboratories have a key role to play in the analysis and interpretation of that data, thereby providing healthcare professionals with information to guide decision-making. “Historically we’ve been a transactional enterprise,” he says. “Whether in a hospital or reference laboratory, we receive an order, collect the specimen, perform the test, report the results, and that’s the end of our involvement. While we certainly need to continue providing those services, we now also need to go beyond that traditional role and analyze the data in the context of other information about the patient or about the population – that’s what will provide both clinical and economic value. It’s no longer just a matter of what a patient’s cholesterol level is, but also what that level means for that particular patient.”