This debate asks the hard question of whether a physical exam adds more than show in the evaluation of an asymptomatic adult. The pro-exam camp argues a routine comprehensive physical exam aligns with patient expectations (granted this is not the best argument for its intrinsic value) but also affords the opportunity to catch “must-not-miss” findings (think: melanoma, large aneurysm, valvular disease). The opposing view notes extensive data indicates general physical exams have little to no effect on all-cause, cancer, or cardiovascular mortality. At the same time, exams with low pretest probabilities can generate false positives, overtesting, and overtreatment. In the end, a problem-based exam may win the day. | Nigam, N Engl J Med 2026
