If I am not sick, why go to the doctor?

May 8, 2011 7:51 PM

What should I ask at a medical check up?

I am one of those people who only goes to the doctor when I am sick. I have health insurance, so it is not a matter of cost. I hate going to the doctor and I just don't see the reason. I had a "check up" about 10 years ago and I didn't see the use in it. I have seen the doctor since then for minor illness, a hysterectomy and a major operation on my knee (realignment of the knee cap).

Perhaps I might see the use if I had something to ask the doctor. I don't have any physical problems. I do have high blood pressure, which is under control. The only thing I am actually interested in is seeing a dermatologist to check my skin for cancer. I cannot see the dermatologist until I see my gp. So I made a appointment to see the gp. AND the only reason why I want to see the dermatologist is because my husband is bugging me, not because I think I have skin cancer.

Prior to my appointment I had a blood panel done. It was all very good. So now I am really thinking of cancelling the appointment.

I am 53 and other than childhood physicals, I have had only two physicals in my life. I am normal weight with no physical problems.

(I do go to the dentist for check ups, since that actually seems to do something.)

So you healthy folks who do go for check ups, why do you? What do you ask? What should I ask? I don't think check ups keep one healthy, am I wrong, do they?

posted by wandering_not_lost to health & fitness (19 answers total)

Part of the benefit is establishing a healthy baseline and having a relationship with a doctor--knowing what's normal for you and having a doctor to call who has access to your earlier blood tests, knows your medical history, etc.

So I would definitely make sure she has records of your surgery, knows about your high blood pressure, and anything else that has been a medical issue for you in the past.

She also needs your family's medical history, which will help if something mysterious happens.

Of course she will check your blood pressure, which needs to be monitored regularly. She will also check your heart with an EEG (I think that's what it is), listen to it, listen to your lungs, and all that good stuff.

Anyway, the next time you get sick or have a problem, you have a doctor to see who already has all of this information.

It's also a lot easier to get in to see a doctor if you have a pre-existing relationship with them. Doctors often hold slots open for pre-existing patients who need to see someone right away. If you've never seen them, they often want you to get a physical first (for all the above reasons--medical history, family history, etc.)

(I had a doctor catch a heart problem at a routine checkup, so I guess my other question would be--how do you know nothing is wrong unless you check? Not everything is obvious to a layperson or has symptoms that you'll identify as a problem.)
posted by the young rope-rider at 8:00 PM on May 8, 2011 [3 favorites]

My cancer was caught during a routine pelvic exam which was part of my physical. I felt perfectly healthy. Lots of people feel perfectly healthy when they find out that they aren't.

Go for your physical. Popping in once a year for half an hour to get checked out is worth it. If you hate going to the doctor when you're healthy, imagine how much you would hate going to the doctor all the time because you're sick. Best to catch things early before they become real problems.
posted by Felicity Rilke at 8:30 PM on May 8, 2011 [2 favorites]

You should ask whether and how often you should have a mammogram and colonoscopy. I suspect that's not what you want to hear, but you should do it anyway. You should ask whether you're at risk for osteoporosis and if so what you should do about it. (Do *a lot* of research before you let them put you on drugs for it, though.) Checking for skin cancer is good. My dad's skin cancer was caught early at a routine doctor's appointment, and as a result he just needed surgery and not any chemo or radiation.
posted by craichead at 8:34 PM on May 8, 2011 [5 favorites]

Well, when I go for a checkup, it's pretty much my annual pelvic exam. In fact, when a woman makes an appointment for a preventative annual physical, at my doctor's office, that means pelvic exam. I asked an older coworker if that was normal, and she said yea, so I guess that's what it is?

I also get bloodwork but that's because of some surgery where the surgeon wants me to check in every year, and I get some prescriptions filled. But, like you, I've often wondered if it was really necessary other than that.

However, I think alot of it is that my doctor is not very good (I am in the process of finding a better one) and doesn't really ask me how I am or anything. I can certainly see how a good doctor could be tracking over the years and be able to pick up on things that might be wrong, especially as you get older.
posted by cabingirl at 8:34 PM on May 8, 2011

If cost is not a concern, I think it would be best to go through with the check-up. Blood tests don't tell the whole story - even if you have no specific complaints, the doctor will do a physical examination along with some important screening tests, like a pap smear. It's not fun to be poked and prodded so intimately, and in all likelihood the doctor may not find any abnormalities, but for a lot of diseases you don't want to wait until you're symptomatic to start investigating. I would say the benefit of potentially catching a disease process early on outweighs the inconvenience of the appointment.
posted by mossicle at 8:34 PM on May 8, 2011

Oh, something you can ask is to have your vitamin D levels checked. Lots of people are chronically vitamin D deficient which can contribute to a number of problems. Also ask your doctor what she feels are the most important things for you to be monitoring at this age. Bone mineral density? Cholesterol? Skin changes? Breast exams (and if so, what kind? Mammogram? Ultrasound? Something else?) Much of what you should be on the look out for can be determined by your doctor once she's looked at your family medical history.
posted by Felicity Rilke at 8:35 PM on May 8, 2011

the young rope-rider, an EEG is to check your brain waves, it's an EKG for your heart.

wandering_not_lost, I think there are other benefits to seeing a doctor that you haven't considered. Aside from the benefits already mentioned (having a doctor who knows you when you get sick, which is, I agree, very important), the benefit of a doctor for a healthy person is not only to keep you healthy, but also to find out when you need medical assistance despite the fact that you may not have any symptoms to indicate that. Many people falsely believe that if something is truly wrong with them, they will know. This is not true. There are many important medical problems that cannot be 'felt', but can be detected by a physician before it's too late.

For example:
- If your blood pressure gets out of control, you may not notice any difference in how you feel, but you would be at risk for a stroke
- Your cholesterol level is not something you can feel getting high, but it puts you at risk for heart disease
- Pre-diabetes and insulin resistance will be detected by your physician and allow you to try to take steps to prevent the complications of diabetes

Other benefits that physicians can serve you are helping to ensure that you have the proper screening tests to detect cancer either before it becomes cancer, or before it becomes a large/invasive cancer, when it is still easily treatable:
- Pap smears for cervical cancer
- Colonoscopy (if you're old enough to have had a hysterectomy, this could be consideration!) for colon cancer
- Mammogram for breast cancer
etc.

And as your husband points out, having a dermatologist screen you for skin cancer is another important thing for many of us. I'm a doctor myself, and I don't count on my own examination of myself to diagnose skin cancer - that's what dermatologists are for.

You also need regular vaccinations, such as flu vaccine, possibly pneumonia vaccine depending on your age, and updates on tetanus and pertussis vaccines. Your physician will track this for you.

Finally, a physician can give you advice on your lifestyle to help you stay as healthy as you are, i.e. diet and exercise, etc. Just being normal weight does not mean that your diet and exercise are optimal.

I see the comments are piling up and are probably of a similar nature to mine, so I will submit now...
posted by treehorn+bunny at 8:39 PM on May 8, 2011

1) Baseline! This is really the most important thing, and will only get more important as you age. You're healthy now, but chances are that at some point in your hopefully long future life, things will be out of whack some way or another. However, the acceptable standard range for various measurables has to be broad enough to accommodate everyone, so significant changes in your particular health can be hidden by the breadth of the standard range. Unless you have a record from when you're healthy, your doctor won't know that you're off, and might miss a significant sign.

2) Are you getting regular mammograms? If not, why the heck not? Don't mess around with cancer risks.

3) Chances are that there are tiny things that nag you - for me it's acne and bunions at the moment. Sometimes those things aren't easily fixable, but other times they are, so it's worth asking about them while you're there anyway. It'd be a shame to continue living with something that bothers you if there's an easy solution.
posted by you're a kitty! at 8:40 PM on May 8, 2011

Just wanted to modify my previous comment to say that even if cost were a concern, it would still be a good idea to get checked up as often as you could afford it. Health is pretty darn important.
posted by mossicle at 8:48 PM on May 8, 2011

Do you still have your cervix (sometimes they leave it in depending on the type of hysterectomy done)? If so, then you should be getting pap smears. And you should still have a yearly pelvic. And a breast exam. And a mammogram. And if you haven't had a baseline colonoscopy, you should probably have that done too. Ditto a full blood workup to check your vitamin levels and cholesterol.
posted by elsietheeel at 8:51 PM on May 8, 2011

Are your shots up to date? I had a nasty experience where my cornea got scratched and I had to get a tetanus shot b/c mine was more than ten years old (I'm usually really good about that kind of thing!) and the scratching implement was dirty and then I spent like a week convinced I was going to get tetanus of the eyeball (my doctor-friend said, "Don't worry, it'll be tetanus of the central nervous system ACQUIRED through your eyeball." so helpful.).

Anyway, get up to date on vaccinations, especially if you interact with babies (what with pertussis in particular going around) or with immunocompromised people, which you might not know about.

As others have noted, you get various tests done where you might FEEL fine but where the test might reveal an early, developing problem. In that case, yes, a check-up keeps you healthy. As do vaccines.
posted by Eyebrows McGee at 9:20 PM on May 8, 2011

Well, you need regular girlie checkups even if you already had your engine pulled.
Get your vaccinations updated. California is having a pertussis epidemic. If you live here you should get that. Get your mammo. You're over 50 now, time for some colon screening.

Basically it gives you a chance to go over things with your doctor when you are not having some kind of a problem. Problem visits are focused on the problem. A check up should be focused on your overall health and and problem prevention.
posted by SLC Mom at 10:22 PM on May 8, 2011

I don't think check ups keep one healthy, am I wrong, do they?

They don't, no.

So you healthy folks who do go for check ups, why do you?

They go because it gives the illusion of control over something (our health, our bodies, aging, mortality) we have limited control over. Also, in the US, it's a cultural ritual--it's drilled in from childhood that if you are a good girl and go to your checkup, it will keep you safe like a talisman. We believe that disease is something you "fight," and there is almost a moral imperative to "do all you can do," even if there's no medical evidence it actually makes people healthier.

The value of so-called preventative care is highly debatable and subjective, and I really think you need to decide exactly what you want because otherwise you may have someone trying to push you into a bunch of screening that may have marginal value for you, or (worse) that you just flat don't want.

Annual Physical May be an Empty Ritual

On Evidence-Based Medicine

For healthy women with no symptoms of disease, a routine pelvic exam serves little purpose

The Myth of Early Detection

The Myth of Prevention

(I am not, despite the harshness of the above, discounting screening altogether. However, screening has risks and is not a panacea, despite what most people would have you believe.)
posted by Violet Hour at 10:28 PM on May 8, 2011 [4 favorites]

As Violet Hour pointed out, a lot of the things done at annual physicals have no evidence to support them.

However, there is an organization that has critically examined the evidence for preventive services and ranks them (A-D, and I for incomplete): the U.S. Preventive Services Task Force.

I like the organization, and it sounds like you will too: They tend to be on the minimalist side. E.g., you might have heard all the noise advocating prostate tests. But they conclude that "that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years." and "USPSTF recommends against screening for prostate cancer in men age 75 years or older."

Detailed list of topics are here and a quick guide is here.

Absolutely, GET A COLONOSCOPY. They save lives. Really. Do not pass go, do not collect $500.

And if you have a cervix, get a pap smear.

The doctor will recommend basic blood tests. They won't hurt, but might not be necessary. E.g., USPSTF is neutral about cholesterol screening for women without increased risk of heart disease.

I've probably missed some others tests that you should have, but the doctor will inform you if there's something else you should get. If you'd like, print out a copy of the guidelines and bring it with you. If the doctor recommends something that you're not sure about, look it up and then have an informed discussion.
posted by Mr.Know-it-some at 6:22 AM on May 9, 2011

Well a recent anecdote that showed me how important checkups are:

My friend's grandmother (mid 60s) was beautiful, fit, and ate a healthy diet. Never went to teh doctor because she was never sick or ill feeling. She thought she had a sinus infection about 2 weeks ago and went to the docs. They did some kind of scan and found tumors and legions all over her lungs. She was admitted to the hospital and got some kind of full body scan and they found she had tumors and legions over most of her organs. She past away last Thursday. Because the cancer has so much time to spread unchecked through basically her entire system, she went from fine to the other side in less than a month.

So, get yourself checked out regularly.
posted by WeekendJen at 6:44 AM on May 9, 2011

Just a note for americans with health insurance... my insurance covers an annual exam at no charge but what i didn't know is that they have a list of items which they consider part of an annual physical and they will not pay for any tests outside that list unless the doctor uses a dignostic code that indicates there was a medical reason for getting that test. Prevenion is not a medical reason. In my case,i ended up paying 250 for a vit D test and 100 fora thyroid test during what i thought would be a free exam. Know your policy before you start asking for the stuff in the news lately.
posted by CathyG at 9:25 AM on May 9, 2011

to Violet Hour, your point that screening tests are not benign is well taken, they must be done in certain populations for certain indications to be beneficial to the population.

However, I disagree with your fatalistic thesis that preventative care is controversial and that trying to prevent disease is futile and beyond our control. The articles you cite do not prove this thesis.

The articles you linked to make reasonable claims about the usefulness of an annual physical or an annual pelvic exam, but that isn't really the point for someone who sees a physician so infrequently. Just because you don't need to see a doctor every year doesn't mean you never have to see a doctor, and just because you don't need a pelvic exam every year doesn't mean you don't need a pelvic exam (See the USPSTF guidelines referenced above on that).

If you're interested in the history of screening tests and preventative medicine, I recommend the recent book The Emperor of All Maladies, which contains an extensive discussion of screening for cancer and how many lives it has lengthened.
posted by treehorn+bunny at 11:59 AM on May 9, 2011 [1 favorite]

Ask the doctor what you should be watching for in the next five to ten years, and the next year. Ask about tests that are interesting but not mandatory. Ask for advice! At my last annual physical I did this, and my doctor said, "Well, you don't smoke... Do you wear your seatbelt all the time? Yeah? Then you're already doing the two best things you can do" [since I am also pretty thin].

I had done a smidgen of reading on screening tests -- primarily for prostate and colon -- and discussed with him wht he feels are their utility. It helped me decide what t do, and also gave me a good feelign for how his mind works. But then, I *always* ask a LOT of questions.
posted by wenestvedt at 12:13 PM on May 9, 2011

[comment removed - please do not turn this into a debate about pap tests.]
posted by jessamyn at 5:41 PM on May 9, 2011