En español | About one-fifth of U.S. adults get an annual physical. But increasingly, research suggests that it's not necessarily a critical appointment to keep. “A number of randomized controlled trials now show that these yearly exams don’t improve people’s health or health outcomes,” says Ateev Mehrotra, M.D., an associate professor of health care policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center. One 2012 review of over 180,000 people, published in the British Medical Journal, for example, found that the practice didn’t do anything to reduce rates of disease or dying from disease. As a result, groups like the Society of General Internal Medicine no longer recommend physicals for people who are healthy, without any symptoms of illness.
Part of the concern, says Christine Laine, M.D., editor in chief of Annals of Internal Medicine and a senior vice president at the American College of Physicians, is that during an annual exam, your doctor may order tests — such as blood or urine tests, or an electrocardiogram (EKG) — that aren’t necessary in otherwise healthy people. “If your doctor finds something they didn’t need to find, they may end up ordering more tests, which is expensive and can cause you to worry,” she notes.
Instead, if you’re otherwise healthy, with no chronic conditions, you’re best off simply just seeing your physician once a year, or once every two years, for what's come to be known as a wellness check-in or wellness exam — kind of like a physical but without the battery of tests. “Just like infants have well-baby visits, it makes sense to see your provider to make sure you’re up to date on all your needed screening tests, as well as to discuss basic preventative lifestyle strategies like eating healthfully, exercising regularly and getting enough sleep,” Laine says.
But that’s not to say that you should skimp on the doctor visits. Where people go wrong, especially as they age, is putting too much stock in physicals and not enough emphasis on taking charge of chronic conditions. “As you get older there are specific health conditions, such as high blood pressure or type 2 diabetes, that you'll need to monitor with more frequent visits,” says Michael Hochman, M.D., assistant professor of clinical medicine and director of the Gehr Family Center for Implementation Science at the Keck School of Medicine at the University of Southern California.
But if you’re already in your doctor’s office several times a year, you don’t need to schedule a separate wellness exam, too. “During these visits your physician should be able to address any other concerns,” says Laine. “Hauling someone back in for another visit to address preventative health isn’t convenient for patients.”
There is one advantage to scheduling an actual annual wellness visit, Mehrotra notes. You won’t have to shell out an insurance copay, since most plans pay for one of these exams each year. “If you’re in your doctor’s office two to three times a year to monitor a condition, for example, it’s perfectly reasonable to make one of those visits your so-called wellness exam. But you don’t need those head-to-toe exam elements, including annual blood work. Instead you should spend any additional time discussing ways to improve your lifestyle, and any other concerns.”
To help you sort through what you really do — or don't — need every year or so, we've highlighted tests you likely can skip, followed by screenings you really should schedule.
Four Tests You Likely Don't Need
- Pelvic exams There’s no evidence that pelvic exams help detect ovarian cancer or allow doctors to ease benign problems such as fibroids or cysts by treating them earlier, according to a 2014 review in Annals of Internal Medicine.
- Chemistry screens These are groups of tests that are ordered (often when you go in for a physical) to determine your general health status — for example, electrolytes, proteins, and kidney and liver function. But these tests can generate false positives, says Laine, like suggesting you have a liver abnormality when you really don't, and sometimes they aren’t covered by health insurance. There are certain people who should get specific types of blood work each year; someone who is on a diuretic for high blood pressure, for instance, should get his kidney function and potassium levels checked annually, since these types of medications can affect both. But there’s no need to test things like thyroid hormone levels unless someone is showing symptoms of thyroid disease. “If your physician hands you a slip for blood work, you should always ask what tests they are ordering and why they want you to have them, to make sure they’re really necessary,” says Laine.
- Urinalysis Unless you have signs of a urinary tract infection, such as frequent burning while urinating, there’s no need to do this test, says Laine. You may end up being incorrectly diagnosed with a UTI and be treated with antibiotics even though you don’t have an infection.
- Electrocardiogram If you don’t have symptoms of heart disease, there’s no benefit to getting this test, which records your heart’s electrical activity. This test can result in a false positive, which means you’ll have to undergo invasive unnecessary screenings such as a CT angiography.
Screenings You Really Do Need (And When You Can Stop Them)
- Pap smear This test, which checks cells in the cervix for abnormalities that could potentially lead to cervical cancer, should be done every three years until age 65, or every five years if you do HPV testing along with your Pap smear. (This is true even if you’ve had a hysterectomy but still have a cervix.) You can safely stop once you reach age 65 and have had either three consecutive normal Pap tests or two negative HPV/Pap smear results in a row within the past 10 years, with the most recent test performed within the past five years.
- Colon cancer screening Everyone over age 45 needs some form of colon cancer screening, ideally either an annual fecal immunochemical test (FIT) or a colonoscopy, according to guidelines published in June 2018 by the U.S. Multi-Society Task Force on Colorectal Cancer. But almost a quarter of screening colonoscopies in older adults over age 70 are inappropriate, another 2013 study, published in JAMA Internal Medicine, revealed. If results are normal, you don’t need another one for a decade. And you can usually stop all colon cancer screenings after age 75.
- Mammograms Women should get them annually from ages 45 to 54, and after that can switch to every one or two years, according to the American Cancer Society. Women over 75 should talk with their health care provider about whether testing continues to make sense for them. The American Cancer Society recommends continuing these screenings as long as you have a life expectancy of at least a decade.
- Prostate-specific antigen (PSA) screening This test, which measures a protein made by the prostate gland — called a prostate-specific antigen — is controversial because it has a high rate of false positives: Only about 25 percent of men with high PSAs end up having prostate cancer. The U.S. Preventive Services Task Force is against routine screening in men of any age, and the American Urological Association recommends it only for men 55 to 69 who have discussed the pros and cons of testing with their doctor.
- Bone density scan Women should get a baseline bone scan at age 65, and men, at age 70, and both should consult their doctor about having one even earlier if they have risk factors such as rheumatoid arthritis, cigarette smoking or have been using a corticosteroid drug for at least three months. If your bone density is normal, then you don’t need to be screened again for 15 years, according to guidelines released by the American College of Physicians in 2017. If you have osteopenia (low bone density), you should get rechecked every two to five years, depending on severity. You don’t need to get rescreened more often than every five years if you have osteoporosis and are being treated for it, as there’s no evidence that there’s any benefit to more frequent monitoring. There are no recommendations for when to stop screening.