How Bad Is It Really to Not Get an Annual Checkup?

The annual physical has long been billed as a key measure in staying healthy. Once a year, your doc gives you a head-to-toe checkup. With any luck, you're given a clean bill of health and can breathe a sigh of relief. If anything is amiss, the hope is that your provider will identify the problem in the early stages, before it becomes a serious issue.

So if you're among the two-thirds of American adults who don't get a yearly exam, according to a December 2015 Cigna survey, you might be wondering if slacking on doctor's visits could sabotage your health.

Here's the thing: General health checks won't prevent you from getting sick, help you live longer or improve your quality of life, according to a March 2013 review in ​JAMA​. But that doesn't mean you should write off your annual physical altogether. Rather, it's a matter of setting the right expectations based on your age and health history.

We chatted with experts about how often you should get a physical and which preventive care visits you should never skip.

Think of it this way: You're building a connection with your doctor.

"Evidence shows that patients who have an established relationship with their primary care provider appear to have better outcomes in terms of their health," says Ateev Mehrotra, MD, associate professor of health care policy at Harvard Medical School and associate professor of medicine and hospitalist at Beth Israel Deaconess Medical Center.

An April 2014 review in ​PLOS One​ suggests that the patient-clinician relationship has a small but significant positive effect on health results. And a February 2017 ​PLOS One​ study found that when patients had higher trust in their health care professional, they reported healthier behaviors, fewer symptoms, a better quality of life and greater satisfaction with treatment.

"If you have established a relationship with your primary care provider, then when something bad comes on — as it often does in life — they can be a trusted resource," Dr. Mehrotra says. "You won't feel isolated, as so many people do in this situation."

This has important implications: "You might be more likely to put off going to your practitioner about a health problem if you've never met them," says Jabraan Pasha, MD, physician of internal medicine at the University of Oklahoma College of Medicine. "Plus, you might be more inclined to listen to their advice if you already have a comfortable, trusted rapport."

In short: Make it a point to get to know your doctor ​before​ there's an issue.

First, we want to be clear that you should always call your provider if you have a health concern.

"Any debate about the annual physical should never ever be interpreted as not going to the doctor if you feel lousy," Dr. Mehrotra says. "Whenever you are experiencing symptoms, schedule an appointment with your provider."

As for folks who are feeling fine, there's not one right answer. "It is hard to say for sure because there is not any data out there [that has examined this]," Dr. Mehrotra says. But here are some general suggestions:

"My personal recommendation — which is not a professional recommendation — would be to get a physical every three years," Dr. Mehrotra says. This is frequently enough to develop a casual relationship with your doctor.

Dr. Mehrotra's personal recommendation is to go every one to two years. "It becomes more important to build a relationship with your provider as you age," Dr. Mehrotra says. "As you get into your mid-40s — and particularly once you reach your 60s — the incidence of illness starts to pick up."

"Again, this is my personal recommendation, but if you're already seeing your provider regularly for something else — say, if you have high blood pressure or you go every six months for contraception — then I'm not sure whether an additional annual physical is necessary at all," Dr. Mehrotra says. "You already have a relationship with your provider."

However, if you're seeing a specialist for a health issue (rather than your regular provider), then you should still go to your primary care physician on the reg. "It is important to see someone who looks at the big picture," Dr. Pasha says.

Certain genetic disorders lead to an increased risk of illnesses like heart disease or cancer. Still, there's debate about whether or not family history plays a role in how frequently you should go to the doctor.

For example, if you have a strong family history of breast cancer, you should probably be screened for it at an early age and may be advised to get mammograms on a regular basis. "This type of preventive care is really important, but does that mean you should have an annual physical? I'm not so sure," Dr. Mehrotra says. "You don't need an appointment with a doctor to get a mammogram."

Still, if you know you're at higher risk for medical issues and you don't have a strong relationship with your doctor or another health care provider, it can't hurt to hop up on the exam table every year or so.

Even if you opt to skip an annual exam, you should still stay on top of preventive services. For example, people assigned female at birth (AFAB) between the ages of 30 and 65 should be screened for cervical cancer every three years, and those ages 50 to 75 should get mammograms every other year (unless you have a personal or family history of breast cancer). Check out the complete guidelines from the U.S. Preventive Services Task Force.

Preventive care is important because certain conditions might not make you feel sick at first, but they can still be dangerous. "For example, although high blood pressure doesn't hurt, it can damage your heart, arteries, kidneys and brain," Dr. Pasha says. "High cholesterol is a risk factor for heart disease and stroke, while high blood sugar puts you at risk of diabetes — yet you may not notice symptoms of either of these conditions early on."

You might be wondering how you'll receive these necessary screenings if you don't see your doctor every year. "The majority of the time, it happens during other visits," Dr. Mehrotra says, pointing out that just over 80 percent of preventive services — such as mammograms, Pap smears and cholesterol screenings — were ordered outside of an annual physical. "We looked at the data, and our health care system does a pretty solid job of ensuring people get the preventive care they need or want."

What your annual physical includes depends on your provider, age, sex and health status.

"Your physical versus my physical versus your friend's physical are all going to be different," Dr. Mehrotra says. "The questions asked, the components of the physical exam performed and whether or not your provider orders tests varies quite a bit."

That said, here's an idea of what you might expect:

You'll typically be given a form to jot down info about your health history — immunizations, medical conditions, hospitalizations and screening tests — as well as current symptoms. You may be asked to list allergies and medications you're taking, including the dosage and reason you're taking it. There's often sections about sexual health, exercise and substance use. There might also be questions about your family health history.

The convo with your doctor will usually cover some of the same ground as the questionnaire. Your provider might also offer counseling about weight loss, exercise, diet and tobacco use.

After the health interview, your practitioner will probably step out of the room while you take off your clothes — including undies — and change into a robe (you usually leave it open in the back). This way, they are able to observe your whole body.

This includes taking your temperature and measuring your blood pressure, pulse and respiratory rate.

"Your physician might inspect your ears for signs of an ear infection or ear wax buildup," Dr. Pasha says. "They will look inside your mouth for concerning lesions or issues with your teeth or tonsils." They may peek at your eyes, nose and sinuses too.

On to your neck: "They are checking for enlarged lymph nodes and making sure your thyroid is not swollen or an unusual texture," Dr. Pasha says.

They might listen to your lungs and heart with a stethoscope to screen you for signs of cardiovascular disease. "They want to be sure that your breath is clear and you don't have a heart murmur or irregular heartbeat," Dr. Pasha says.

Moving on to your abdomen: "Your provider will thump and press on your stomach, while listening with a stethoscope," Dr. Pasha says. "They are checking for lumps, pain or abnormal bowel sounds."

If you were AFAB, your checkup might include a breast exam, pelvic exam and Pap smear. Depending on your age and family history, your doctor may suggest a mammogram screening.

Those assigned male at birth (AMAB) might receive a genital and prostate exam. No matter what your sex, your practitioner might recommend a screening for colorectal cancer, based on your age and risk factors.

"Most adults will get a routine blood test, which measures blood sugar, cholesterol, electrolytes and blood count," Dr. Pasha says. Your doctor will look for any red flags pointing to diabetes, high cholesterol or other health issues.

Taking care of the following will help make your visit a success.

If your physician doesn't already have a copy of your medical history, bring them with you or have them faxed to the office.

"Talk to your parents, siblings and grandparents about health issues they've experienced, since your doctor will likely ask you about this," Dr. Pasha says.

"Be sure to include the dose and what you're taking it for," Dr. Pasha says.

"Some bloodwork can only be done on an empty stomach," Dr. Pasha says. "In that case, you shouldn't eat or drink — besides water and black coffee or tea — 12 hours before your appointment."

"This is a great occasion to reflect on your health and think through anything that is bothering you," Dr. Mehrotra says.

Advance directives are essentially a living will, explaining how you'd like medical decisions to be made in the event that you are too sick to speak for yourself. If you haven't already set up your advance directives, your doctor might give you a form at your physical.

"Have a conversation with your loved ones ahead of time about what you would or would not want if something unfortunate were to happen to you," Dr. Mehrotra says.

The amount you'll fork over depends on the services you receive, how long the visit lasts, where you live and what insurance plan you have.

Uninsured? The Medical Expenditure Panel Survey (MEPS) found that the average expense for a visit to a primary care provider was $186 in 2016.

If you have insurance, certain preventive services may be available at no cost to you, depending on your plan and age, according to the U.S. Department of Health & Human Services. These may include blood pressure, diabetes and cholesterol tests; cancer screenings such as mammograms and colonoscopies; health counseling; and vaccinations.

Even if you're insured, you might still have a copay for a preventive care visit. A January 2014 MEPS report found that in 2012, the average copay for people with an employer-sponsored health plans was between $23 and $27.

Now here's where things get murky: Technically, the purpose of a preventive visit is to assess your general health, identify risks and discuss how to stay healthy. If you bring up an existing health problem, illness, medical condition or injury during your annual physical, the clinic may code the appointment as an "office visit" instead of a "preventive visit." In that case, you could be responsible for shouldering more of the cost of the appointment, as well as any related lab work or tests that the doctor orders based on your concerns.

According to the 2013 ​JAMA​ review we mentioned earlier, the expense of annual physicals adds up. Researchers estimate that $322 million a year is spent on lab work that isn't recommended by any official guideline groups. What's more, they suggest that follow-up tests from false positives during general health checks is a substantial contributor to the $210 billion spent annually on unnecessary medical services.

"If you are otherwise healthy and getting preventive care, then it is not that bad," Dr. Mehrotra says.

But if it's been a while or you don't have a trusted health care provider you can call with questions about your health, then it's probably a good idea to get a checkup on the schedule.