The Slacker's Guide to Seeing the Doctor
How long can you put off a check-up before it really starts to matter?
Annual physicals. Twice-yearly dental cleanings. Who has time for all these appointments—not to mention the cash for copayments?
We're not saying you shouldn't get checked out: Many preventive services, such as cervical cancer screenings and blood pressure tests, have been shown to detect potentially dangerous diseases before they cause irreversible harm to your health. But in other cases, you might not actually need to go the doctor as often as you think to stay healthy. Modern medicine has gotten pretty good at helping the sick, but some of the tests and treatments given to healthy people are unnecessary at best and expensive and harmful at worst, says Adam Cifu, a professor of medicine at the University of Chicago.
Exactly how long you can put off each visit depends partially on your health history and your personal tolerance for risk. We combed the research and asked a few experts to help us nail down the, well, laziest possible preventive care schedule for the young and symptom-free. (Of course, we'll say it again: If you have warning signs of a health problem—like an unexplained lump, a chest pain, a toothache, or messed-up vision, don't be stupid. Make an appointment.)
A regular physical exam
You should go: Once every other year, at most, or when you have a symptom that indicates something is off with your health.
Why: Believe it or not, there's no scientific evidence supporting the idea of an annual check-up if you feel fine. In fact, a recent research review by the Department of Veterans Affairs found regular physicals often result in unnecessary tests that freak you out and waste your cash, with no benefit to your health. The Society of General Internal Medicine actually lists physicals as one of five things member doctors should avoid.
The idea that a major, hidden disease would be detected by listening to an apparently healthy patient's heart and lungs borders on ridiculous, Cifu says. Some screening tests are recommended for healthy adults, including blood pressure checks every two years and a cholesterol panel around age 35. But you don't necessarily need a doctor's visit to get them; a health fair or corner clinic works just fine.
You're pushing it if: You haven't seen a doctor for more than five years, Cifu says. Besides checking your blood pressure and cholesterol—risk factors for heart disease—your doc will ask questions to screen you for things like depression, domestic violence, unhealthy habits, and offer advice on medications, lifestyle changes, or other treatments.
You should go: Every three months to one year.
Why: The risk for oral health problems like cavities and gum disease varies widely based on your genetics and your lifestyle (for instance, whether you smoke or how many sugary sodas you drink). That's why you might end up with a mouthful of fillings despite brushing and flossing, while your friend who neglects dental hygiene has no issues. That variation makes it tough to give blanket guidance on how often you need a professional cleaning and exam, says Paulo Camargo, a periodontist and professor at the UCLA School of Dentistry in Los Angeles.
The official American Dental Association position holds that you should go to the dentist as regularly as he or she recommends. Many will advise visiting every six months, but this has little backing in research. In 2013, British researchers attempted to gather all the data on the topic and came up with exactly one study they deemed poor-quality—not enough evidence to draw any conclusions. Later that same year, a University of Michigan study used a genetic test and risk factors like smoking and diabetes to break patients into high-risk and low-risk groups. Those at high risk had fewer teeth extracted if they came in for twice-yearly visits, while low-risk patients did just as well with one.
You're pushing it if: You wait longer than a year (though note that in their national guidelines, the Brits say you can go two). Longer than six months is risky if you already have cavities or periodontitis, smoke, or have diabetes. During that time, a small cavity can turn into an area of decay large enough to require a root canal, and mild gum disease can turn into bone loss in your jaw, Camargo says.
You should go: Annually once you're age 21 or sexually active, with a Pap smear every three to five years.
Why: The nation's ob-gyns would like you to put your feet in the stirrups at least once per year. The American College of Obstetricians and Gynecologists recently reaffirmed its long-held position that even healthy women make an annual visit that includes a pelvic exam. But a recent research review in the Journal of Women's Health finds support for pelvic exams thin. (Even ACOG acknowledges their recommendation of this invasive inspection is based on expert opinion, not data.)
Evidence does support screening for cervical cancer. The Pap test can find abnormal and precancerous cells, allowing doctors to remove them before they become malignant. The test also detects cancer in early, treatable stages. Experts once recommended them yearly. But now, research has shown you get just as much protection against cancer—and fewer false positives—if you get Pap tests every three years. Once you hit 30, you can either keep up that schedule or get a test for the human papillomavirus (HPV)—which causes most cervical cancers—plus a Pap test every five years.
You're pushing it if: You wait longer than five years—though you might be able to go longer, if an HPV test comes back clear, Cifu says. (One recent Dutch study in The BMJ suggests there's no harm in waiting as long as ten years, since it takes a while for HPV to turn into cancer—but that assumes both tests are perfect and don't give false negatives, a level of risk most Americans aren't comfortable with, Cifu says.)
You should go: Once or twice a year or only if you spot something unusual, depending on who you ask.
Why: Diagnoses of the deadly skin cancer melanoma have increased in recent decades—this year alone, 76,000 Americans will develop it and an estimated 10,000 people will die from the disease. However, research hasn't shown that having a professional inspect your dermis protects you, Cifu says. The US Preventive Services Task Force, an independent group charged with making evidence-based recommendations to keep you healthy, issued findings earlier this year, saying there's not enough data to endorse full-body skin exams.
However, dermatologists like Kally Papantoniou, of Advanced Dermatology P.C. in New York, still advise getting a yearly check—or twice-yearly if you have lots of moles and a strong history of ultraviolet exposure and sunburns. While she agrees more studies of people without a family history of melanoma are needed to determine the optimal frequency, Papantoniou says she treats many people for the disease who don't have traditional risk factors, such as fair skin and a history of tanning bed use.
You're pushing it if: Regardless of whose position you espouse, you're in trouble if you ignore unusual moles or growths, especially those that follow the ABCDE rule of melanoma: asymmetrical shape, borders or edges that are irregular, color variation within the mole, diameter of 6 millimeters or larger (about the size of a pencil eraser), and evolution, or any change in size and shape.
You should go: Every year or two, or anytime you have a symptom such as pain, redness, or a vision change.
Why: The American Academy of Optometry recommends most adults get an eye exam—either from an ophthalmologist, who's a medical doctor, or an optometrist, who isn't—at least once every two years. But for the most part, eye diseases like glaucoma and macular degeneration strike at older ages, says Nicholas Volpe, chair of ophthalmology at Northwestern University Feinberg School of Medicine in Chicago. So if you don't have vision problems or other symptoms, you probably don't need to go that frequently.
The equation changes if, like about three-fourths of Americans, you wear glasses or contact lenses. Besides vision testing to see if your prescription's still accurate, your eye doc will check the fit of your contact lenses and inspect you for signs of infection. If you're nearsighted, you're at risk for retinal detachment, which can cause blindness—a dilated eye exam can reveal early warning signs, Volpe says.
You're pushing it if: You wait longer than five years if you don't wear glasses or contacts, or once a year if you do, especially if you're nearsighted, Volpe says.