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Rewriting My Medical Manifesto

How often do you go to the doctor? How often should you?

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by Sarah Mahoney

Well-Being
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Plenty of people love to go the doctor, but I am not one of them. I’m lucky to be pretty healthy, but I often have a nagging sense of guilt that I’m neglecting myself: Am I due for a mammogram? A dental checkup? Are my reading glasses the right prescription? At dinner, when friends talk their cholesterol levels, I stare into my plate: Even though I write often about health, I can’t play this game. I’m sure my doctor mentioned it at my last checkup, but I can’t remember when that was. Three years ago? Four?

Let me be clear: If I’m sick or injured, I’m all about getting myself taken care of. I had shoulder surgery recently, for example, and never missed a follow-up physical therapy appointment. I live in the land of ticks, and last year was worried enough about a bite that I had myself tested for Lyme disease. But I slack off on the many recommended wellness and preventative suggestions.

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In my defense, I’ve got plenty of justification. Despite the medical world’s rush to promote wellness and prevention, there’s not a lot of evidence that it works. The annual physical is a good example. While it’s a ritual tens of millions of Americans swear by, research—including a major study that looked at more than 180,000 patients—finds they do nothing to reduce mortality rates, either overall or for such specific problems as heart disease or cancer.

Even with proven screening tests, we may have gone overboard. For women in midlife, pap smears are now suggested every three years instead of annually. (In some cases, it’s every five.) And many experts now suggest that for women in their early fifties like me, every-other-year mammograms are just as effective as annual imaging. For men, the recommendations about who should and shouldn't take the simple screening test for prostate cancer are also complicated.

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With so much conventional wisdom in flux, it’s easy to let healthcare slide. So this month, I broke from my routine and scheduled a routine checkup with my primary-care doctor, who is a great guy. I told him I was taking a trip abroad, and he looked at my vaccination records. (Turns out I hadn’t had a tetanus shot this century, so he arranged that.) He noticed a weird-looking mole and referred me to a dermatologist. (And no, I have never gone to a dermatologist for oft-recommended skin-cancer screening.) When we began reviewing the blood work, he started with, “Everything is normal,” but I forced myself to pay attention anyway. I listened especially hard to the four numbers I know are critical, according to the American Heart Association: body-mass index, blood glucose level, blood pressure and cholesterol. (While they were all in the healthy range, the next time it comes up at a dinner party, I’ll be able to commiserate—my LDL is on the high side, too.)

When he asked if I had other questions, I brought up my far-from-annual check-ups. “I don't come in for a check-up every year. Or even every other. Is that OK?”

“It’s funny,” he says. “It seems like more and more patients are asking me about that. And I’ve seen the studies that say annual physicals don’t prevent much. But I think it’s about relationships, and getting to know patients so that when something is wrong, I can provide better care. But how often? There’s no recommendation, so really, that’s up to you.”

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Up to me? I like that. So I decided to write my own rules. I will stick to the recommendations of my gynecologist, and see her annually. Ditto the dentist, who makes scheduling twice-annual cleanings a breeze. I will continue to ignore the steady stream of reminder postcards from my eye doctor, but will call and make an appointment when I realize I can no longer read the New Yorker without squinting. And for regular checkups, I’m giving myself three years without guilt, but promise to schedule a check-up at least once every presidential term. 

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