The annual physical is dead. Comprehensive care shouldn’t die with it

I believe the Canadian health system should move away from the routine annual physical—but not from comprehensive care. They are not the same thing.Choosing Wisely Canada and the Canadian Task Force on Preventive Health Care are right to warn that routine annual checkups for asymptomatic adults is low-value medical practice.In practice, however, the message “avoid the annual physical” can be misread as “do not make time for comprehensive care.” That interpretation risks weakening core functions of family medicine and pushing care toward reactive, episodic encounters when patients most need longitudinal prevention, medication review, attention to function and mental health and recognition of social context. The unresolved problem is what should replace the annual physical in everyday Canadian family medicine: a model that preserves comprehensiveness, continuity and equity without returning to low-value checkups.Comprehensive care assessment is not a nostalgic ritual. Done well, it is the visit where evidence-based prevention, chronic disease risk, medication review, mental health, function and social context come together in one conversation. It is where we ask the questions that do not fit neatly into a 10-minute appointment: What are you worried about? What has changed at home? Are your medications helping or harming? Are you safe? Are food, income, work, caregiving or housing pressures affecting your health?Much illness does not arrive labelled as a chief complaint. Depression may present as fatigue. Risky substance use may be hidden behind insomnia. Cognitive decline may appear first as missed appointments or medication confusion. Falls risk, loneliness, medication harms and financial strain often surface only when a physician has enough time—and enough relationship—to ask.Comprehensive care has high practical yield, like updating history and risk factors; reviewing immunizations and cancer, cardiovascular and metabolic screening based on current recommendations; checking blood pressure and other indicated measurements; reconciling medications and identifying opportunities to deprescribe; assessing function, falls risk and cognition when appropriate; screening for depression, anxiety and substance use when clinically indicated; and identifying barriers such as poverty, housing insecurity, food insecurity, caregiving burden, language barriers, low health literacy and limited transport.The practical safeguard is to separate assessment from automatic testing. A physician can spend time listening, examining selectively, updating risk, counselling, deprescribing, supporting behaviour change and arranging evidence-based screening that benefits the patient, along with clear communication: avoiding a test is not neglect when the test is unlikely to help and may cause harm. Shared decision-making, documentation of clinical judgment and written after-visit summaries can make stewardship visible and acceptable.Stewardship also means investing effort where it has the highest yield—supporting behaviour change, optimizing chronic disease management and addressing mental health and social complexity. Comprehensive assessment is how family physicians work responsibly.A practical model would look like this:Make comprehensive assessments periodic and risk-stratified, not automatically annual. Patients with multimorbidity, frailty, polypharmacy, mental health concerns, high preventive-care gaps or significant social risk should be prioritized.Use evidence-based preventive tools. Checklists, reminders and shared decision-making prompts can help close proven care gaps without opening the door to low-value testing.Protect time for complexity. Prevention, deprescribing, family context, mental health and social needs require cognitive work. Payment and scheduling models should recognize that work.Resource follow-through. It is not enough to identify depression, food insecurity, addiction, falls risk or medication harm if the system has no pathway to help.Communicate clearly with patients. Patients need to understand why some tests are not helpful, what prevention is recommended, and what they can do between visits.Comprehensive assessment cannot depend solely on individual physician goodwill. It requires appointment templates that protect time for complexity, team roles that support mental health, addictions, social work and medication review, and information systems that identify patients due for interventions. Payment models should recognize cognitive work, continuity, coordination and prevention rather than only the volume of brief episodic encounters.Practice management is not peripheral: poorly designed systems can erode quality, damage the public’s experience of care and demoralize clinicians and staff. Digital tools can strengthen, but cannot replace clinical judgment. Used well, digital health tools can preserve comprehensiveness while reducing low-value care; used poorly, they can widen inequities for patients with limited digital access or health literacy.The equity issue. Social determinants of health are not usually discovered through lab tests. They are discovered through relationship, trust and conversation. If comprehensive assessment disappears, the patients most likely to lose out are those whose risks are complex, quiet and socially shaped.The right things should be measured. Prevention often succeeds quietly: the fall that does not happen, the medication harm that is avoided, the depression identified before crisis, the emergency department visit that never occurs. If policy measures only same-day access, short appointments and short-term costs, comprehensive care will look inefficient even though it prevents the downstream events that are not counted.Canada should continue to discourage routine, unfocused annual physicals. But should be very clear that comprehensive family medicine is worth protecting. If health systems crowd it out, patients will not simply need fewer visits. They will often present later, sicker and more socially precarious than they needed to be. A sustainable health system should not be built primarily around the cost of care once illness is established, but around what happens before care is neededThe question is not whether we can afford comprehensive care.The question is whether we can afford the consequences of losing it.Dr. Foluso Ola is a Pelham, Ont. family doctor.

The annual physical is dead. Comprehensive care shouldn’t die with it

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