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July 15, 2023 8:51 AM Subscribe
Why is it recommended to get an annual physical?
I haven't had a physical in many years.
BUT
I see my endocrinologist two times a year (PCOS, Type 2 diabetes) and get blood work and urine tests prior to those visits. I also see my gynecologist yearly where I get urine tests and also pap smears every three years.
Between these two doctors I feel like I'm receiving great medical care and I like them both.
I feel super ignorant asking this but, given the above, what would an annual physical provide that I'm not already getting for my health? I've been told that I really should find a GP and I'm kind of like... why?
I'm totally willing to find a GP and get a physical if there's something I am missing, but I don't know what I'm missing. Can you help me understand?
And yes I recognize that I am a grown ass woman who should probably know the answer to this already and I feel pretty embarrassed about it, go easy on me if you don't mind.
I haven't had a physical in many years.
BUT
I see my endocrinologist two times a year (PCOS, Type 2 diabetes) and get blood work and urine tests prior to those visits. I also see my gynecologist yearly where I get urine tests and also pap smears every three years.
Between these two doctors I feel like I'm receiving great medical care and I like them both.
I feel super ignorant asking this but, given the above, what would an annual physical provide that I'm not already getting for my health? I've been told that I really should find a GP and I'm kind of like... why?
I'm totally willing to find a GP and get a physical if there's something I am missing, but I don't know what I'm missing. Can you help me understand?
And yes I recognize that I am a grown ass woman who should probably know the answer to this already and I feel pretty embarrassed about it, go easy on me if you don't mind.
This post was deleted for the following reason: posters request -- frimble
here in DK it is not recommended to get an annual physical, but to reach out when you have symtoms/feel poorly.
posted by alchemist at 8:57 AM on July 15, 2023 [3 favorites]
posted by alchemist at 8:57 AM on July 15, 2023 [3 favorites]
Best answer: It sounds like you already get a lot of specialist care so you might not need an annual physical as much as the next person! In general I can tell you that my annual is where my GP says huh, that’s a lot of arthritis for someone your age; you’re 45, get a screening colonoscopy; hey, has anyone ever told you you have a minor heart murmur?
That said, I also tend to be pretty proactive or know what I need to do to get specialized help. It’s an extra way to make sure I’m not missing something that he, an actual doctor, can spot.
That’s one narrative. I am not super timely in scheduling them, perhaps because like you I have a small army of specialists and I’m pretty good at coordinating all their care.
He did identify a vitamin D deficiency that wouldn’t have fallen into anybody else’s realm.
posted by chesty_a_arthur at 8:58 AM on July 15, 2023 [19 favorites]
That said, I also tend to be pretty proactive or know what I need to do to get specialized help. It’s an extra way to make sure I’m not missing something that he, an actual doctor, can spot.
That’s one narrative. I am not super timely in scheduling them, perhaps because like you I have a small army of specialists and I’m pretty good at coordinating all their care.
He did identify a vitamin D deficiency that wouldn’t have fallen into anybody else’s realm.
posted by chesty_a_arthur at 8:58 AM on July 15, 2023 [19 favorites]
Ideally your GP/primary care doc would be the one to look at the bigger picture while your specialists just look at their area of specialization. And your GP would be the one to see for any illnesses not related to your specialists' areas. So, like, if you get bronchitis, you see a GP, not a gynecologist. They'll also keep track of your immunization needs.
posted by mareli at 9:03 AM on July 15, 2023 [14 favorites]
posted by mareli at 9:03 AM on July 15, 2023 [14 favorites]
Harvard Medical School says the entire annual physical model needs to change but patients should still have a relationship with a primary health care provider.
I also have specialists but would never had them in the first place if it wasn't for my GP. She was the one who took me seriously and got me in to see a hematologist, a cardiologist, and a pulmonologist. When I go in for my annual physical, she looks at all my specialist visits and talks with me about them and any new findings. She also has enough of a history with me that when I call and say my lungs feel tight, she gets me in the office that same day, which definitely wouldn't happen with my pulmonologist (even though I really like him and his practice; they're just too busy to see patients same day).
posted by cooker girl at 9:07 AM on July 15, 2023 [9 favorites]
I also have specialists but would never had them in the first place if it wasn't for my GP. She was the one who took me seriously and got me in to see a hematologist, a cardiologist, and a pulmonologist. When I go in for my annual physical, she looks at all my specialist visits and talks with me about them and any new findings. She also has enough of a history with me that when I call and say my lungs feel tight, she gets me in the office that same day, which definitely wouldn't happen with my pulmonologist (even though I really like him and his practice; they're just too busy to see patients same day).
posted by cooker girl at 9:07 AM on July 15, 2023 [9 favorites]
Best answer: How old are you? As you age, you need mammogram & Pap (OB/Gyn), colonoscopy, cholesterol & blood sugar (Endo), maybe other screenings, some vaccines. really, you don't need to go to doctors a lot unless health issues arise, but as I get older, things arise more often and it's useful to have a generalist available. You have a scenario that's working for you.
posted by theora55 at 9:07 AM on July 15, 2023 [2 favorites]
posted by theora55 at 9:07 AM on July 15, 2023 [2 favorites]
Best answer: I get my free (thanks again Obama!) annual check-up with my OBGYN - I'll change that strategy at a certain age I guess, but you can totally get a general wellness check from your OBGYN, and have it covered.
posted by coffeecat at 9:19 AM on July 15, 2023 [8 favorites]
posted by coffeecat at 9:19 AM on July 15, 2023 [8 favorites]
It may very well be that your specialists are covering a lot of the same space for you! Especially if you're filling in some of the gaps with something like urgent care, a pharmacy for your vaccinations, etc.
But it can, for some people, be useful to have a generalist who's looking at the big picture of their health more than a specific system / part of the health process. It can be useful to have someone keeping on top of changes in health recommendations and letting you know that X test is useful as a baseline at your age, but you can stop doing Y test because it's no longer recommended. A GP might be a useful place to go to get your vaccines if you don't have easy access to, or don't like, your other options like a local pharmacy. A GP might be able to be your one-stop-shop for keeping all your prescriptions prescribed and refilled, if you have one who will cheerfully look at what your specialist prescribed and be willing to write the refills on it so you don't have to keep track of six different prescribers. A GP will do broad sorts of screenings for things like depression, substance abuse, domestic violence, etc. that your specialists might or might not do as part of their routine practice A GP might be the person you go to with bronchitis or conjunctivitis or some other routine ailment that your specialist isn't going to handle for you, if you'd rather not deal with that stuff via urgent care.
posted by Stacey at 9:21 AM on July 15, 2023 [2 favorites]
But it can, for some people, be useful to have a generalist who's looking at the big picture of their health more than a specific system / part of the health process. It can be useful to have someone keeping on top of changes in health recommendations and letting you know that X test is useful as a baseline at your age, but you can stop doing Y test because it's no longer recommended. A GP might be a useful place to go to get your vaccines if you don't have easy access to, or don't like, your other options like a local pharmacy. A GP might be able to be your one-stop-shop for keeping all your prescriptions prescribed and refilled, if you have one who will cheerfully look at what your specialist prescribed and be willing to write the refills on it so you don't have to keep track of six different prescribers. A GP will do broad sorts of screenings for things like depression, substance abuse, domestic violence, etc. that your specialists might or might not do as part of their routine practice A GP might be the person you go to with bronchitis or conjunctivitis or some other routine ailment that your specialist isn't going to handle for you, if you'd rather not deal with that stuff via urgent care.
posted by Stacey at 9:21 AM on July 15, 2023 [2 favorites]
Best answer: I have to because they won't renew my hypertension and cholesterol meds if I don't, and I'm not presently under any specialist care. I'm not a fan, but I go, because I need those meds, the occasional pap smear or vaccination (just got first shingles vax), and authorizations for stuff like mammograms and colonoscopies.
What you have going sounds pretty okay to me. You're getting the preventive stuff, it sounds like.
posted by humbug at 9:24 AM on July 15, 2023 [3 favorites]
What you have going sounds pretty okay to me. You're getting the preventive stuff, it sounds like.
posted by humbug at 9:24 AM on July 15, 2023 [3 favorites]
It’s not a thing at all in the UK either. Some guesses as to why that might be:
Maybe the US does do it because:
* It helps discover underlying issues before they become symptomatic, improving treatment outcomes.
* Healthcare companies in the US benefit from charging insurance companies for millions of extra appointments/labs each year.
* US insurance companies feel they reduce their liability by having regular checks to reduce the likelihood of illness being found at late-stage (no idea if that’s true, just speculating).
Maybe the UK doesn’t do it because:
* The NHS can’t afford it, or at least the cost/benefit isn’t seen as good enough for a nationalised healthcare system with straining budgets.
* Widespread testing and checks when there are no symptoms or elevated risk factors can see people getting treated for things that might otherwise remain permanently undiscovered and unproblematic (I’ve had a string of these in recent years - had some blood tests for long covid which have in turn led to the discovery of four different health conditions. Two turned out to be faulty findings in the initial screening, though that was only discovered after considerable further screening; the other two are being monitored but have caused me no symptoms whatsoever and I suspect if it weren’t for the initial unrelated tests, I might have gone my whole life without knowing I had them, which would have been much less stressful and much cheaper for the NHS.)
posted by penguin pie at 9:24 AM on July 15, 2023 [2 favorites]
Maybe the US does do it because:
* It helps discover underlying issues before they become symptomatic, improving treatment outcomes.
* Healthcare companies in the US benefit from charging insurance companies for millions of extra appointments/labs each year.
* US insurance companies feel they reduce their liability by having regular checks to reduce the likelihood of illness being found at late-stage (no idea if that’s true, just speculating).
Maybe the UK doesn’t do it because:
* The NHS can’t afford it, or at least the cost/benefit isn’t seen as good enough for a nationalised healthcare system with straining budgets.
* Widespread testing and checks when there are no symptoms or elevated risk factors can see people getting treated for things that might otherwise remain permanently undiscovered and unproblematic (I’ve had a string of these in recent years - had some blood tests for long covid which have in turn led to the discovery of four different health conditions. Two turned out to be faulty findings in the initial screening, though that was only discovered after considerable further screening; the other two are being monitored but have caused me no symptoms whatsoever and I suspect if it weren’t for the initial unrelated tests, I might have gone my whole life without knowing I had them, which would have been much less stressful and much cheaper for the NHS.)
posted by penguin pie at 9:24 AM on July 15, 2023 [2 favorites]
I guess also, there are loads of people out there who never go to their doctor and cruise their way obliviously into an early grave from high blood pressure/cholesterol etc. Universal regular health checks are the best way to catch those people, even if they’re superfluous for people like you who are already getting regular medical contact.
posted by penguin pie at 9:26 AM on July 15, 2023 [5 favorites]
posted by penguin pie at 9:26 AM on July 15, 2023 [5 favorites]
Best answer: Probably the biggest factor in the "routine physical" is the bloodwork, which you are having done via endo probably. Many people get this care from their gynecologist if that applies, or from their specialists if they have a highly managed health condition (but not all! My friend was surprised when his Oncologist sent him to his GP for his yearly in between chemo sessions, but the Onc pointed out that a) they're not necessarily looking for all the standard stuff b) he's going to be in close contact with his GP going forward and maintaining that baseline is important to compare year-over-year).
But you should ask your specialists! Maybe they think you are doing this with a GP somewhere.
posted by Lyn Never at 9:33 AM on July 15, 2023 [2 favorites]
But you should ask your specialists! Maybe they think you are doing this with a GP somewhere.
posted by Lyn Never at 9:33 AM on July 15, 2023 [2 favorites]
You’re already getting a lot of attention and care from healthcare providers, so you might be all set personally. Here are general reasons why annual physicals can be helpful:
- They run through a bunch of preventive health questions with you, like: Alcohol? Smoking? Losing your balance? Feel safe at home? Seatbelt use? Depression symptoms?
- They also help make sure you’re aware of age-appropriate preventive health procedures, like colon cancer screening, breast cancer screening, vaccines and boosters, and cholesterol tests. The computer system usually has automated reminders based on your chart, and this prompts the doc to discuss the options with you and maybe even help schedule them.
- They physically touch you and look at you, and they might notice things that you haven’t spotted yet (especially in places like on your back or inside your ears and eyes).
- When you do it year after year, you build continuity and trending patterns that they can look at. Stuff like “Your cholesterol has been high for a few years now. We made a note last year to talk about it this year if nothing changed” or “Hmm, your weight has gone done a lot in just 3 years” or “You’ve done these screenings for X number of years with no findings, so I think you can do them less often now.”
- Sometimes you need an established relationship with a PCP to get referrals to specialists.
posted by cadge at 9:42 AM on July 15, 2023 [5 favorites]
- They run through a bunch of preventive health questions with you, like: Alcohol? Smoking? Losing your balance? Feel safe at home? Seatbelt use? Depression symptoms?
- They also help make sure you’re aware of age-appropriate preventive health procedures, like colon cancer screening, breast cancer screening, vaccines and boosters, and cholesterol tests. The computer system usually has automated reminders based on your chart, and this prompts the doc to discuss the options with you and maybe even help schedule them.
- They physically touch you and look at you, and they might notice things that you haven’t spotted yet (especially in places like on your back or inside your ears and eyes).
- When you do it year after year, you build continuity and trending patterns that they can look at. Stuff like “Your cholesterol has been high for a few years now. We made a note last year to talk about it this year if nothing changed” or “Hmm, your weight has gone done a lot in just 3 years” or “You’ve done these screenings for X number of years with no findings, so I think you can do them less often now.”
- Sometimes you need an established relationship with a PCP to get referrals to specialists.
posted by cadge at 9:42 AM on July 15, 2023 [5 favorites]
The reason it's recommended is because noticing problems early is better than trying to cure them later.
I never bothered when I was younger but now that I'm past 50 and watching my elders and even my cousins slowly fall apart I'm comforted by a comprehensive check up and blood test every year or so. After 60 I'm planning on cranking that down to every 6 months.
It has to be handled with care though. If you send doctors looking for a problem they will find one so you have to do some research and decide how much you care about what they come back with.
posted by Tell Me No Lies at 9:53 AM on July 15, 2023 [4 favorites]
I never bothered when I was younger but now that I'm past 50 and watching my elders and even my cousins slowly fall apart I'm comforted by a comprehensive check up and blood test every year or so. After 60 I'm planning on cranking that down to every 6 months.
It has to be handled with care though. If you send doctors looking for a problem they will find one so you have to do some research and decide how much you care about what they come back with.
posted by Tell Me No Lies at 9:53 AM on July 15, 2023 [4 favorites]
Best answer: So you're asking two different questions here, (a) do you need to have an annual physical, and (b) do you need to have a GP?
I understand there can be legitimate disagreements about the first, but for the second, I'd say that in the US it's a really good idea to have an established relationship with a GP. I mostly see my oncologist, but for some things, their office does tell me to see my GP, and it's so much better to have an established relationship with one for a few reasons.
(1) I have a GP I like and trust, so I'm not scrambling to find someone who just happens to be the only person who takes my insurance and accepts new patients and who might also be a huge jerk. It's especially important for women and people who are marginalized to have a doctor who takes them seriously.
(2) Getting an appointment with a GP is almost certainly going to be faster and easier if you are already an established patient.
(3) If you need to see a different specialist, the GP you like and trust will probably be a good point person for that.
(4) GPs know a lot about a lot of things and may catch something your specialist won't. At one point, my GP called my psychiatrist to tell him he needed to find a different med for me because the one he put me on was giving me high blood pressure. My psychiatrist wasn't checking my blood pressure.
(5) Your insurance might require you to get a referral from a GP to see a specialist.
BTW, five doctors (family practitioners) really dropped the ball in the six months when I had cancer symptoms but nobody caught it. Part of the problem was that there was a lot of turnover, so I was never seeing the same doctor twice. And the other was that I was going in for individual problems (all, it turned out, caused by cancer) and not for a physical. If I'd been having regular complete blood counts, which are part of an annual physical, it almost certainly would have been caught much earlier. By the time someone (a cardiologist) decided to check my hemoglobin, it was so low he called me at home and sent me straight to the ER. A bunch of people on my cancer support board have reported that they were diagnosed because their GP noticed an off blood test and decided to pursue it.
So I guess I do think it's a good idea to have physicals. And I definitely think it's a good idea to have a GP.
posted by FencingGal at 10:05 AM on July 15, 2023 [8 favorites]
I understand there can be legitimate disagreements about the first, but for the second, I'd say that in the US it's a really good idea to have an established relationship with a GP. I mostly see my oncologist, but for some things, their office does tell me to see my GP, and it's so much better to have an established relationship with one for a few reasons.
(1) I have a GP I like and trust, so I'm not scrambling to find someone who just happens to be the only person who takes my insurance and accepts new patients and who might also be a huge jerk. It's especially important for women and people who are marginalized to have a doctor who takes them seriously.
(2) Getting an appointment with a GP is almost certainly going to be faster and easier if you are already an established patient.
(3) If you need to see a different specialist, the GP you like and trust will probably be a good point person for that.
(4) GPs know a lot about a lot of things and may catch something your specialist won't. At one point, my GP called my psychiatrist to tell him he needed to find a different med for me because the one he put me on was giving me high blood pressure. My psychiatrist wasn't checking my blood pressure.
(5) Your insurance might require you to get a referral from a GP to see a specialist.
BTW, five doctors (family practitioners) really dropped the ball in the six months when I had cancer symptoms but nobody caught it. Part of the problem was that there was a lot of turnover, so I was never seeing the same doctor twice. And the other was that I was going in for individual problems (all, it turned out, caused by cancer) and not for a physical. If I'd been having regular complete blood counts, which are part of an annual physical, it almost certainly would have been caught much earlier. By the time someone (a cardiologist) decided to check my hemoglobin, it was so low he called me at home and sent me straight to the ER. A bunch of people on my cancer support board have reported that they were diagnosed because their GP noticed an off blood test and decided to pursue it.
So I guess I do think it's a good idea to have physicals. And I definitely think it's a good idea to have a GP.
posted by FencingGal at 10:05 AM on July 15, 2023 [8 favorites]
I'm used to the model in the UK, so there's a bias there but I do think it's a good idea to have a go-to doctor for routine low-level things, or where you don't know which specialist is the right one to see. You may as well make it the same office and if you need more coordinated care they can provide it.
It's supposed to be sensible to have routine physicals from time to time, although (again with a UK bias) annually seems overkill to me. Sort of middle age and then every 5-10 years if there are no problems seems more sensible, just because some things do catch up on you in middle and later age. And that's separate to whether you should have screenings for common cancers etc.
posted by plonkee at 10:11 AM on July 15, 2023
It's supposed to be sensible to have routine physicals from time to time, although (again with a UK bias) annually seems overkill to me. Sort of middle age and then every 5-10 years if there are no problems seems more sensible, just because some things do catch up on you in middle and later age. And that's separate to whether you should have screenings for common cancers etc.
posted by plonkee at 10:11 AM on July 15, 2023
Best answer: As an aside to your general question, if/when you do decide to look for a primary care doctor, seek out an internist rather than a GP. Children are noisy noncompliant disease vectors and internists strictly treat adults.
posted by phunniemee at 10:11 AM on July 15, 2023
posted by phunniemee at 10:11 AM on July 15, 2023
Best answer: Established relationship is a main reason to have a GP and see them annually. I can contact my GP through the year for answers and referrals and prescription renewals that would not go through if I had not been their within the last year. When that emergency issue comes up, it is worth it to have a current GP. Your endo may be taking that role for you.
posted by RoadScholar at 10:12 AM on July 15, 2023 [1 favorite]
posted by RoadScholar at 10:12 AM on July 15, 2023 [1 favorite]
At least here in the US, a not insignificant chunk of the population pretty much never go to a doctor unless/until things have gotten so bad they absolutely can't avoid it. So, the effort to get people to get a wellness check once a year (and have it done at no cost to the patient) is best looked at an effort to make seeing a doctor as friction-free as possible, with the understanding that many still aren't going to go. "You can lead a horse to water..." and all that.
FWIW, and IME, when insurers first became required to cover a yearly physical, they were pretty damned thorough events. Bloodwork, cardiograms, fingers up the butt, etc. Today, though, the "wellness check" is barely a handful of "How ya doin?" questions, a "take a deep breath", and maybe a blood draw at a lab. "Wellness check" ≠ "Physical"
posted by Thorzdad at 10:16 AM on July 15, 2023 [5 favorites]
FWIW, and IME, when insurers first became required to cover a yearly physical, they were pretty damned thorough events. Bloodwork, cardiograms, fingers up the butt, etc. Today, though, the "wellness check" is barely a handful of "How ya doin?" questions, a "take a deep breath", and maybe a blood draw at a lab. "Wellness check" ≠ "Physical"
posted by Thorzdad at 10:16 AM on July 15, 2023 [5 favorites]
My experience is that specialists often don't see things outside of their specialties; e.g. my allergist treated my shortness of breath as asthma. It wasn't until I finally went to my GP that I got the tests that revealed I'd been walking around with blood clots in my lungs for weeks.
I like having someone who knows my baseline state of health and thus what I mean when I say something really hurts or I had to stop and sit down in the mud halfway through a minor hike (if it hadn't been my established GP I told that to, another doctor might've shrugged and chalked it up to my size).
I've never been sold random tests visiting a doctor for my annual physical unless I brought up a real problem, fwiw. For the most part I think of them as establishing a baseline and a relationship. It's absolutely ideal to do this while your health is being managed well, instead of when it's not.
(I've always been lucky enough to have my GP and specialists in the same, not-for-profit group, which I love and recommend if you can. My last couple of GPs have also been DOs, and I appreciate that because they're open to lifestyle changes and other approaches but also fine with just prescribing something when it's needed. They've been great at seeing the big picture with my health.)
posted by wintersweet at 10:18 AM on July 15, 2023 [4 favorites]
I like having someone who knows my baseline state of health and thus what I mean when I say something really hurts or I had to stop and sit down in the mud halfway through a minor hike (if it hadn't been my established GP I told that to, another doctor might've shrugged and chalked it up to my size).
I've never been sold random tests visiting a doctor for my annual physical unless I brought up a real problem, fwiw. For the most part I think of them as establishing a baseline and a relationship. It's absolutely ideal to do this while your health is being managed well, instead of when it's not.
(I've always been lucky enough to have my GP and specialists in the same, not-for-profit group, which I love and recommend if you can. My last couple of GPs have also been DOs, and I appreciate that because they're open to lifestyle changes and other approaches but also fine with just prescribing something when it's needed. They've been great at seeing the big picture with my health.)
posted by wintersweet at 10:18 AM on July 15, 2023 [4 favorites]
I take prescription meds for allergies, so I stay on top of getting physicals because the longest a GP has gone without insisting on a physical before providing a refill is two years. Sure, I could see an allergist, but in this case my allergies don't need acute follow up and a specialist appointment has cost $30-50 depending on insurance whereas physicals are always free.
It's also a nice venue for bringing up minor health concerns that I otherwise wouldn't go through the trouble of making an appointment for and get either reassurance or recommendations for a specialist.
posted by fox problems at 10:25 AM on July 15, 2023
It's also a nice venue for bringing up minor health concerns that I otherwise wouldn't go through the trouble of making an appointment for and get either reassurance or recommendations for a specialist.
posted by fox problems at 10:25 AM on July 15, 2023
There is some debate about the value of annual physicals:
Maybe You Should Skip That Annual Physical (NPR, 2015)
TV doctors say annual checkups save lives. Real doctors call bullshit. (Vox, 2016)
posted by meowzilla at 10:45 AM on July 15, 2023 [4 favorites]
Maybe You Should Skip That Annual Physical (NPR, 2015)
TV doctors say annual checkups save lives. Real doctors call bullshit. (Vox, 2016)
posted by meowzilla at 10:45 AM on July 15, 2023 [4 favorites]
Since I have at least eleventy specialists, I was hoping to not have to go out and find a primary, but two of my specialists convinced me that it was necessary to have some sort of relationship with a general practitioner. Things like sprains, bronchitis, bladder infections, warts--are much easily handled through a GP. *Usually* you can get in faster if you are an established patient, and that means at least an introductory wellness exam to establish. References to a specialist means appointments are scheduled quicker, IMHO.
posted by BlueHorse at 11:29 AM on July 15, 2023 [1 favorite]
posted by BlueHorse at 11:29 AM on July 15, 2023 [1 favorite]
Is someone checking your blood pressure? It's pretty important.
posted by H21 at 12:10 PM on July 15, 2023
posted by H21 at 12:10 PM on July 15, 2023
Making sure you're up-to-date on vaccines like TDaP [Tetanus, diphtheria, and pertussis] and shingles vaccines is something you might be missing at specialist offices. CDC recommends tdap or td boosters every 10 years, and a shingles vax if you're over 50.
posted by mediareport at 12:16 PM on July 15, 2023 [1 favorite]
posted by mediareport at 12:16 PM on July 15, 2023 [1 favorite]
Definitely catching underlying issues and just asking general questions. Just recently got my first GP. My last "GP" was my pediatrician over 25 years ago. It was always a money/insurance/no major health concerns thing with me but finally my dad just made me an appointment with his doctor so I started going and there are a lot of things now that I wish I had caught earlier and made an attempt to reverse. Like high blood pressure, high cholesterol, fatty liver, early diabetes, etc. Now I'm tackling all these things and making better choices and changes in my life but I do wish I got the wake up call much sooner. My BP was clocking in at 185/100 and I had no idea.
posted by simplethings at 12:25 PM on July 15, 2023 [1 favorite]
posted by simplethings at 12:25 PM on July 15, 2023 [1 favorite]
I am a 60 year old male. I have never had a physical. I don't like going to the doctor. This led to my poo-poohing an infection that landed me in the ICU for three days on a ventilator, 3 more weeks in the hospital, five surgeries and a bunch of continuing issues. And now I have so many doctors, (mostly surgeons). I did finally get a colonoscopy, my first ever not long ago. And when I had a reoccurrence of a similar infection, I went in the next day, and didn't wait 3 days.
That was only one night in the hospital!
And the only reason I even have a PCP now, is that I couldn't get a referral to a specialist without it. Yeah US medical system.
So I'm sort of coming around to the viewpoint that I should probably do a yearly physical. But, if you are having specialist stuff, they are probably doing a lot of the things already that would happen, blood work, etc. Though I have had a lot of blood drawn and they have never used any of it for a simple cholesterol test...
Early detection is better than late.
posted by Windopaene at 12:34 PM on July 15, 2023
That was only one night in the hospital!
And the only reason I even have a PCP now, is that I couldn't get a referral to a specialist without it. Yeah US medical system.
So I'm sort of coming around to the viewpoint that I should probably do a yearly physical. But, if you are having specialist stuff, they are probably doing a lot of the things already that would happen, blood work, etc. Though I have had a lot of blood drawn and they have never used any of it for a simple cholesterol test...
Early detection is better than late.
posted by Windopaene at 12:34 PM on July 15, 2023
Response by poster: Thanks all for the insight!
My endocrinologist checks my BP and my gynecologist checks my breasts for lumps at my annual. I'm 38 so I suppose at some point soon I'll need to go for yearly mammograms (does that typically become the thing when one turns 40?).
I definitely see how having a doc look at the big picture could be helpful. I have been getting flu/COVID vaccines through my pharmacy and going to urgent care on the rare occasions when I need someone to look at me (usually if I suspect I have strep as I seem to be prone to tonsillitis).
With regards to prescriptions: my gynecologist writes my birth control prescription, my endocrinologist writes my prescriptions for T2D and PCOS (more on this in a sec), and my psychiatrist writes my prescriptions to treat bipolar 2 and anxiety.
I have been seeing my gynecologist for 13 years, my endocrinologist for 10 years, and my psychiatrist for 11 years. My endo and gyno are both a part of the same large medical group and communicate with either as needed with regards to me care since the PCOS is sort of under both their "jurisdiction" as it were.
I have a concern that at this point trying to introduce a PCP into the mix who doesn't know me nearly as well as these three do is that they will want to interfere with long established treatment regimens that are working for me. I especially have concerns with regards to the fact that I am on Ozempic since there's been so much weird junk journalism about it and most docs who aren't endocrinologists are not educated about it. Ozempic is controlling my A1C so well that I don't need to be on any other medicine for diabetics and it's also dramatically improved the insulin resistance that my PCOS presents with. I've also lost 40 pounds on it since January and those were 40 I needed to lose and I really should lose another 30 to get me out of "obese" territory and maybe another 20 after that to get to an healthy weight for my height, build, and family history of health conditions that are comorbid with excess weight. My endocrinologist is thrilled with my results on Ozempic and will keep me on it indefinitely, probably lowering the dose to a small maintenance one once she feels my diabetes is constantly controlled and hopefully my IR goes away. I don't want a random PCP who doesn't know my medical history judging me for taking Ozempic and trying to talk me into stopping. I also don't want a random PCP who doesn't know my medical history looking at the three meds I take for mental health reasons and deciding I should change something there too.
Can PCP's "override" the treatment protocol established and prescribed by specialists? I don't want to try to get a PCP and end up in an argument with them about this. Going off any of the medication I currently take is absolutely non-negotiable for me.
posted by nayantara at 12:51 PM on July 15, 2023
My endocrinologist checks my BP and my gynecologist checks my breasts for lumps at my annual. I'm 38 so I suppose at some point soon I'll need to go for yearly mammograms (does that typically become the thing when one turns 40?).
I definitely see how having a doc look at the big picture could be helpful. I have been getting flu/COVID vaccines through my pharmacy and going to urgent care on the rare occasions when I need someone to look at me (usually if I suspect I have strep as I seem to be prone to tonsillitis).
With regards to prescriptions: my gynecologist writes my birth control prescription, my endocrinologist writes my prescriptions for T2D and PCOS (more on this in a sec), and my psychiatrist writes my prescriptions to treat bipolar 2 and anxiety.
I have been seeing my gynecologist for 13 years, my endocrinologist for 10 years, and my psychiatrist for 11 years. My endo and gyno are both a part of the same large medical group and communicate with either as needed with regards to me care since the PCOS is sort of under both their "jurisdiction" as it were.
I have a concern that at this point trying to introduce a PCP into the mix who doesn't know me nearly as well as these three do is that they will want to interfere with long established treatment regimens that are working for me. I especially have concerns with regards to the fact that I am on Ozempic since there's been so much weird junk journalism about it and most docs who aren't endocrinologists are not educated about it. Ozempic is controlling my A1C so well that I don't need to be on any other medicine for diabetics and it's also dramatically improved the insulin resistance that my PCOS presents with. I've also lost 40 pounds on it since January and those were 40 I needed to lose and I really should lose another 30 to get me out of "obese" territory and maybe another 20 after that to get to an healthy weight for my height, build, and family history of health conditions that are comorbid with excess weight. My endocrinologist is thrilled with my results on Ozempic and will keep me on it indefinitely, probably lowering the dose to a small maintenance one once she feels my diabetes is constantly controlled and hopefully my IR goes away. I don't want a random PCP who doesn't know my medical history judging me for taking Ozempic and trying to talk me into stopping. I also don't want a random PCP who doesn't know my medical history looking at the three meds I take for mental health reasons and deciding I should change something there too.
Can PCP's "override" the treatment protocol established and prescribed by specialists? I don't want to try to get a PCP and end up in an argument with them about this. Going off any of the medication I currently take is absolutely non-negotiable for me.
posted by nayantara at 12:51 PM on July 15, 2023
I'm supposed to have a yearly physical because I'm on Medicare. The odds are pretty good I'm going to get diagnosed with something or other in the very near future, given my age. They've tried a couple of times but I don't bother. And I need someone whose office can direct me to the correct specialists. However, my husband who died in September refused to get a colonoscopy when it was first suggested by his doctor, and colon cancer was what killed him just when he should have been able to enjoy his retirement.
posted by Peach at 12:52 PM on July 15, 2023 [1 favorite]
posted by Peach at 12:52 PM on July 15, 2023 [1 favorite]
Best answer: I mean, your PCP can say "I think you should do x instead of y" but you can say "I'd rather not". They aren't in charge of anything and they can't change the medications another doctor is prescribing you.
posted by wintersweet at 1:02 PM on July 15, 2023 [7 favorites]
posted by wintersweet at 1:02 PM on July 15, 2023 [7 favorites]
Best answer: I think that usually the generalist doctors defer to the specialists.
posted by Windopaene at 1:03 PM on July 15, 2023 [4 favorites]
posted by Windopaene at 1:03 PM on July 15, 2023 [4 favorites]
The NHS doesn't offer annual physicals for patients - it's a reactive system, where people go to the doctor when they believe there's something wrong with them, rather than a proactive system where people get extensive screening.
On the NHS, cervical screening is every 3 years for women aged between 25-49, and every 5 years up to the age of 64, and not at all after that. Mammograms are only offered for women after they turn 50, and then only every 3 years, up to the age of 71 (this is the case even for someone like me who had a benign breast tumour in 1985 and another one in 2006).
There just isn't the money or staff available to offer annual physical exams to people. But the consequence is that by the time someone starts showing symptoms of an illness, it can result in treatment needing to be more aggressive or invasive than if there'd been screening for that particular disease, or maybe even too late to do anything.
As others have said, the insurance model in the USA is the primary driver - testing/screening generates income for the medical profession and provides data for the insurance companies to set levels of cover and premiums, as well as the obvious benefits to patients in early diagnoses of illness or disease.
posted by essexjan at 1:19 PM on July 15, 2023
On the NHS, cervical screening is every 3 years for women aged between 25-49, and every 5 years up to the age of 64, and not at all after that. Mammograms are only offered for women after they turn 50, and then only every 3 years, up to the age of 71 (this is the case even for someone like me who had a benign breast tumour in 1985 and another one in 2006).
There just isn't the money or staff available to offer annual physical exams to people. But the consequence is that by the time someone starts showing symptoms of an illness, it can result in treatment needing to be more aggressive or invasive than if there'd been screening for that particular disease, or maybe even too late to do anything.
As others have said, the insurance model in the USA is the primary driver - testing/screening generates income for the medical profession and provides data for the insurance companies to set levels of cover and premiums, as well as the obvious benefits to patients in early diagnoses of illness or disease.
posted by essexjan at 1:19 PM on July 15, 2023
Not a thing in Canada. In fact, my doctor specifically told me they no longer do them.
posted by dobbs at 3:29 PM on July 15, 2023 [1 favorite]
posted by dobbs at 3:29 PM on July 15, 2023 [1 favorite]
I'm a boomer white male with type 2 diabetes, high blood pressure, and obstructive sleep apnea. My GP takes care of the first two. Besides needing glasses, I see an optometrist because of possible diabetes complications, and he's the one who (believe it or not) alerted me to the possibility of sleep apnea, so that led to the sleep specialist.
My insurance gives me free preventive care, which means my annual physicals, and the lab tests my doctor orders at the same time, are free. My GP is the first person of whom I ask questions, and the person who knows which specialists are needed -- which isn't often, because she takes care of most of my ailments (I've never needed to see a specialist for my diabetes, for instance). She helps also reminds me to keep up on my vaccinations.
posted by lhauser at 3:53 PM on July 15, 2023
My insurance gives me free preventive care, which means my annual physicals, and the lab tests my doctor orders at the same time, are free. My GP is the first person of whom I ask questions, and the person who knows which specialists are needed -- which isn't often, because she takes care of most of my ailments (I've never needed to see a specialist for my diabetes, for instance). She helps also reminds me to keep up on my vaccinations.
posted by lhauser at 3:53 PM on July 15, 2023
A few people have mentioned that annual physicals are not a thing in the UK, which is true, but once you reach 40 you are invited for an NHS Health Check every five years, so it’s not an entirely reactive system.
posted by kyten at 3:59 PM on July 15, 2023 [1 favorite]
posted by kyten at 3:59 PM on July 15, 2023 [1 favorite]
Before she retired a few years ago, my GP and my gyno were one and the same. In at least my part of Canada (each province has it’s own health care system, and while there are a lot of commonalities, there’s also a reasonable amount of variation), we have a regular “Well Woman” exam, which isn’t a complete physical but with my GP I was able to also talk to her about any new or ongoing issues of any sort, and she also ordered regular blood tests to track down one of those ongoing issues. I hadn’t yet aged into regular blood work for the usual old age issues, though, so that was unusual. I forget if I’m in the every two year or every three year category now, but the regular check-in was reassuring. That’s an understatement, actually. Having grown up in the US, without a GP and only having health insurance about half the time, getting that level of help just keep an eye on my health or knowing that I had a regular time to ask any questions that maybe weren’t important enough to schedule an appointment for but that helped me be better informed and take better care of my health was revelatory.
I just got a new GP after a couple years without (which made accessing continuing care a huge hassle). He’s… not as communicative or proactive, and hasn’t mentioned anything about regular physicals or wellness appointments. For the couple of things I’ve asked him about so far, the response has been “Huh, I don’t know that off the top of my head. Maybe google it?” He did sort of ask a follow-up question at my most recent visit, that was at least somewhat related to what I had described about the issue in my previous visit. But he looked rather deer in headlights when I mentioned perimenopause in passing as something I would likely be facing in the medium term during my initial intake appointment. But he’ll also write me referrals and prescriptions and has some notes from my last visits as well as my longer medical history with all of my previous GP’s notes, and I expect I may have to be slightly insistent, but can probably continue getting the same blood work screenings every two years. The Well Woman exam that I had with a random doctor when I didn’t have a GP was definitely narrowly focused and not the same sort of general check-in as I had been accustomed to previously, and I expect that will continue to be the case (I don’t think my new GP does Well Woman exams, and I wouldn’t be super comfortable with him doing one for me even if he does in general, based on my interactions so far). It certainly feels like my overall quality of care has gone down with this new setup. Maybe when I finally get in to see the two specialists I’ve finagled referrals for in two to three years, that could replace some of the attention to detail that it feels like has been lost?
Mammograms start at 40 here. (That’s another separate program in my province. As are colonoscopy screenings, which start at 50. So I guess it seems like my province is moving toward having specific programs for the most common regular preventative screenings?)
posted by eviemath at 5:04 PM on July 15, 2023
I just got a new GP after a couple years without (which made accessing continuing care a huge hassle). He’s… not as communicative or proactive, and hasn’t mentioned anything about regular physicals or wellness appointments. For the couple of things I’ve asked him about so far, the response has been “Huh, I don’t know that off the top of my head. Maybe google it?” He did sort of ask a follow-up question at my most recent visit, that was at least somewhat related to what I had described about the issue in my previous visit. But he looked rather deer in headlights when I mentioned perimenopause in passing as something I would likely be facing in the medium term during my initial intake appointment. But he’ll also write me referrals and prescriptions and has some notes from my last visits as well as my longer medical history with all of my previous GP’s notes, and I expect I may have to be slightly insistent, but can probably continue getting the same blood work screenings every two years. The Well Woman exam that I had with a random doctor when I didn’t have a GP was definitely narrowly focused and not the same sort of general check-in as I had been accustomed to previously, and I expect that will continue to be the case (I don’t think my new GP does Well Woman exams, and I wouldn’t be super comfortable with him doing one for me even if he does in general, based on my interactions so far). It certainly feels like my overall quality of care has gone down with this new setup. Maybe when I finally get in to see the two specialists I’ve finagled referrals for in two to three years, that could replace some of the attention to detail that it feels like has been lost?
Mammograms start at 40 here. (That’s another separate program in my province. As are colonoscopy screenings, which start at 50. So I guess it seems like my province is moving toward having specific programs for the most common regular preventative screenings?)
posted by eviemath at 5:04 PM on July 15, 2023
The Canadian provincial health systems are all structured around having a GP as you main or initial point of contact for health care, so not having one really makes accessing care much, much harder. It sounds like that’s not the case for you, however.
posted by eviemath at 5:09 PM on July 15, 2023
posted by eviemath at 5:09 PM on July 15, 2023
Best answer: Occasionally, what you want is for the generalist to tell you not to listen to some of your specialists. I think you are probably several decades from this, but it comes up in geriatric care. Specialists are keen to treat absolutely everything that is in their niche, but are often less keen on discontinuing treatments that may be interacting badly, or having tough conversations about goals of care. I presume yours are all still benefiting you, though, as you are in your prime, and I would be surprised if a GP is going to try to get in the way of that. (If they did... you could always switch, eh?)
posted by eirias at 7:05 PM on July 15, 2023 [4 favorites]
posted by eirias at 7:05 PM on July 15, 2023 [4 favorites]
Best answer: The blood tests ordered by my endocrinologist are very specific to my hyperthyroidism - they are not general panels for cholesterol, iron levels, etc. The blood tests ordered by my GP at my yearly physical test a much wider range of measures and are meant to catch any emerging issues before they become serious. (This is how I found out that was hyperthyroid in the first place.)
posted by gnutron at 7:40 PM on July 15, 2023 [2 favorites]
posted by gnutron at 7:40 PM on July 15, 2023 [2 favorites]
Best answer: My current primary doctor does an ECG. None of my previous doctors did though, and none of my specialists do, so I like getting that done now. Double check what bloodwork you get checked vs what a primary doctor would check just to make sure you're not missing anything. You can also give directly to Quest or Labcorp (or another local bloodwork lab) to get that done, and if anything comes up that's out of range, then you can make an appointment with that type of specialist or with a general primary care doctor.
Also, with my insurance, the annual physical bloodwork is completely covered, but bloodwork ordered by a specialist is not. So if I do have to see a specialist it's nice to have recent bloodwork results to show them so they might order less tests even if they do order bloodwork (aka less $$).
posted by never.was.and.never.will.be. at 8:30 PM on July 15, 2023
Also, with my insurance, the annual physical bloodwork is completely covered, but bloodwork ordered by a specialist is not. So if I do have to see a specialist it's nice to have recent bloodwork results to show them so they might order less tests even if they do order bloodwork (aka less $$).
posted by never.was.and.never.will.be. at 8:30 PM on July 15, 2023
I’m in the US. I’ve had rather more contact with our health care system than I would like in the last year, since I had some postcovid issues.
I had a bad time with my PCP’s urgent response team (they told me I shouldn’t see a cardiologist; I did anyhow; I was right). It was bad enough I switched offices (new office is bad in other ways, sigh, I may go back to the first office and just avoid their rapid response team).
But I am still glad I had gone for an “annual” physical every few years in the last decade. It means that the cardiologist could see the long term pattern of eg cholesterol, weight, etc. Sometimes the change in the data is as important as the number itself, and getting a baseline in your “average” state is really useful
when you are feeling below average.
posted by nat at 1:46 AM on July 16, 2023 [2 favorites]
I had a bad time with my PCP’s urgent response team (they told me I shouldn’t see a cardiologist; I did anyhow; I was right). It was bad enough I switched offices (new office is bad in other ways, sigh, I may go back to the first office and just avoid their rapid response team).
But I am still glad I had gone for an “annual” physical every few years in the last decade. It means that the cardiologist could see the long term pattern of eg cholesterol, weight, etc. Sometimes the change in the data is as important as the number itself, and getting a baseline in your “average” state is really useful
when you are feeling below average.
posted by nat at 1:46 AM on July 16, 2023 [2 favorites]
Speaking of baselines....
An annual or biannual comprehensive medical exam means that the team can see your health over time. This saves unnecessary tests and costs.
Is you blood pressure always that low? Has that spot on your mammogram been consistent over numerous years? Is there a family history at play?
Seconding the need for a recommendation from a primary before seeing a specialist due to insurance rules.
posted by TrishaU at 4:04 AM on July 18, 2023
An annual or biannual comprehensive medical exam means that the team can see your health over time. This saves unnecessary tests and costs.
Is you blood pressure always that low? Has that spot on your mammogram been consistent over numerous years? Is there a family history at play?
Seconding the need for a recommendation from a primary before seeing a specialist due to insurance rules.
posted by TrishaU at 4:04 AM on July 18, 2023
This thread is closed to new comments.
posted by toodleydoodley at 8:53 AM on July 15, 2023 [13 favorites]