Preventive Services in Clinical Practice: Designing the Periodic Health Examination

In this issue ofThe Journal, the US Preventive Services Task Force presents the first in a series of background articles and recommendations for preventive measures that can be incorporated into personal health services.¹The periodic health examination has largely replaced the annual physical examination, and the changing patterns of morbidity and major risk factors call for more integration of clinical preventive services into office visits triggered by acute or chronic symptomatic disease. In the 1920s, the American Medical Association and the Metropolitan Life Insurance Company first endorsed the annual physical examination as conferring long-term health benefits. Generations of physicians and patients came to regard the annual examination as the keystone of preventive medicine. In the 1970s, increasing cost consciousness, changing expectations of patients, and refined methods for studying the efficacy of diagnostic tests and maneuvers raised serious questions about the value of the annual checkup.²Clinicians began