For a working-age adult in overall good health without chronic conditions or symptoms to address, how often should they see a primary physician?
It’s hard to give a concrete answer because it really depends on the individual. It depends on their age, their sex, their family history, and their individual risk factors.
The trouble with a nuanced answer like this is that it’s hard to message, but the stakes are high and we want to be sure people get necessary care. We want people to get the vaccines or cancer screenings that are warranted. We want people who have serious underlying conditions like hypertension and don’t know it to become aware of it and get treated. We want to have conversations about a family history of cardiovascular disease or cancer, for example, so that good care plans can be put in place.
Because an optimal interval for a check-in with a primary physician isn’t straightforward, we have a tendency to just make it easy and often say things like, “It’s time for your annual visit.” For some people, that’s fine, and once a year is easy to remember, but checking in annually is admittedly somewhat arbitrary.
The younger a person is, assuming they feel good, checking in less often may be sufficient. I often tell a younger person to come see me “periodically.” For example, “If you’re feeling good, and nothing changes, come see me in a couple of years.”
And the older or more medically complex a person is, particularly if there are things going on in the background – maybe previously diagnosed health issues, or if they’re on chronic medications – they should be seen more often. The reality is, things creep in as we age, and so the chance of something occurring without the patient’s awareness is higher. So once a person is over 50 or so, I might say, “I’d like to see you back in a year, but sooner if anything comes up before then.”
Certainly, if you have symptoms or something happens in the interim like a serious illness, I want to see you right away. But in general, the frequency of routine visits is less often for patients on the lower end of medical complexity, and more often for those on the higher end.
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It sounds like the popular idea of an annual visit is a starting point for a conversation to have with your primary physician about frequency of visits.
Absolutely. At the end of a visit, I’ll say, “We talked about several things today. Here are the risk factors that we identified, and we’re going to keep a close eye on these things. I’d like to see you back in” whatever it happens to be – a year, or two, or what have you. Or in some instances it may be much sooner than that.
There’s no one-size-fits-all answer. How often to follow up, and the care that’s being brought to bear in a visit, needs to be tailored to the individual. So I try not to get into the habit of calling it an annual visit.
Data suggests that Americans go to the doctor less often than people in many other countries for a variety of reasons, including cost, insurance disparities, how health services are delivered, and difficulty in getting appointments. Do you see a problem there?
There are lots of people we ought to be seeing more often. Many of them are feeling fine and have not been seen by a physician in a long time. They may have diabetes or chronic kidney disease and be totally unaware. They may have unhealthy habits – maybe they’re using tobacco, or drinking to excess, or aren’t moving their bodies, or their diet isn’t optimal. These people need to be seen, because these are important things to identify. There are things we can do for these conditions that are likely to reduce their risk of serious outcomes even in the near term.
Unfortunately, access is a problem for many. Some people don’t have health insurance or they’re underinsured, and worry that if they come in and we order labs or an imaging study, it’ll be cost prohibitive. And some people are fearful of what they might learn if they come in, so they delay their visit or avoid it altogether. Also, there’s a significant shortage of primary clinicians, so even for people with adequate insurance, I hear many anecdotes of how hard can be to get connected with someone like me.
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On the flip side of that, is there such a thing as seeking care too often, and does that put stress on the health care system?
There are some patients who don’t have to be seen immediately and may seek care in an inappropriate venue. When people are uninsured, and don’t have access to regular care, they’re more likely to use the ER, often for things that would be better handled outside of an ER, like managing diabetes or evaluating other long standing problems.
Our health care system’s capacity isn’t infinite. If I’m seeing person X, I’m not seeing person Y. Ideally, we’d prioritize patients who are most in need of being seen, since they typically have the most to gain from a visit.
So you can see why it’s challenging to answer the question, “How often should a person who’s doing well be seen?” If someone is on the lower end of medical complexity and doing well, it may be better to space out the visit interval to, say, two or three years, to help ensure access for those who may have more things going on and need to be seen more often. But to be clear, any patient with a new concern – feeling unwell for example – should be seen right away.
Telehealth visits scaled up during the pandemic. Do they still play a role today?
Absolutely. They were an adjustment for all of us, but what I’ve learned over time is there’s a lot that can be accomplished in a telehealth visit, particularly for a preventive visit or for those focused on one or two chronic things like medication adjustments rather than new, worrisome problems like chest pain. Also, we’ve got a handful of patients who live a couple of hours away, and it’s convenient for them to check in by video when appropriate.
If a person is seeing a lot of specialists for various conditions, should they scale back on their primary care visits?
To me, that’s actually a reason to scale up visits with the primary physician. The more clinicians that are being woven into the picture, the more fragmented things can become, and the greater the value of having someone who can approach things holistically. And as things become more medically complicated, preventive interventions like vaccines, for example, may be crowded out and sometimes overlooked. So having someone involved who can be sure all aspects of health are being attended to is valuable.
