Is your annual physical enough?

Many people who want to be proactive with their health schedule an annual check-up with their primary care provider. In my previous role as a family practitioner, I regularly saw patients for these visits. During the appointment, I’d ask about their general health and specifically inquire about serious symptoms, such as chest pain, numbness, tingling, memory problems, and weakness. I’d perform an exam, checking eyes, ears, throat, listening to the heart and lungs, pressing on the abdomen, and testing reflexes. I’d ensure they were up to date with age-appropriate screenings: breast cancer for women, prostate cancer for men, and colon cancer for everyone over 50. We’d discuss vaccines, and some routine bloodwork would be ordered.

This is a good start. But is it enough? If your results come back normal, should you feel confident that you’re free of disease and on the path to optimal health? In my opinion, no.

Here’s the surprising part: what I did as a family doctor was more than what’s recommended by the U.S. Preventive Services Task Force (USPTF). For a patient like me, a 50-year-old married female, non-smoker, with a normal BMI, the evidence-based recommended screenings include:

• Cervical cancer screening (pap smear)

• Folic acid supplementation (to prevent neural tube defects if I become pregnant—which, let’s hope, I won’t!)

• HIV screening (I’ve been married and in a monogamous relationship for 28 years)

• Hypertension screening (blood pressure check)

• Syphilis screening (again, married for 28 years)

• Counseling on smoking cessation and HIV prevention (even though I don’t smoke and have a low risk)
• Hepatitis C screening

A 2014 meta-analysis of six randomized trials found that physicals like these didn’t decrease mortality. I’m not surprised.

Conventional medicine excels at treating acute issues—like a broken arm, a heart attack, or strep throat—and managing chronic disease. But after 20 years in that system, I no longer believe it does enough to prevent disease proactively. And “following the science” isn’t always enough. I understand that patients aren’t always honest on questionnaires—after all, in med school, we were taught to double a patient’s reported alcohol intake to get a more realistic number. But even accounting for that, screening for HIV and syphilis in a stable, long-term marriage doesn’t seem like the best use of resources.

It’s essential to recognize that procedures like colonoscopies, mammograms, and PSA blood tests don’t prevent cancer; they detect it early. Standard bloodwork—checking cholesterol, electrolytes, kidney and liver function, blood count, and basic thyroid levels—provides a limited view of overall health. Normal results are reassuring, but don’t reflect how optimally your body is functioning.

USPTF recommendations also factor in cost-effectiveness. For example, ovarian cancer screening isn’t recommended for average-risk women like me because it’s not cost-effective. But how do you put a price tag on someone’s life? Additionally, screening can bring harm: anxiety from false positives, risks from follow-up testing, and overdiagnosis of conditions that might never have become problematic.

The conventional medical approach is, “Let’s wait until you get sick, then we’ll treat it.”

That might be acceptable for some, but not for me or my patients. We want more for our health and our lives—and we’re willing to go the extra mile.

So what can be done to feel great now and protect against future disease?

Conventional medicine recognizes over 70,000 ICD-10 codes (used for insurance billing), while as a functional medicine doctor, I focus on a few root causes that underlie most chronic diseases:

1. Oxidative Stress – Energy production generates free radicals, which, if not neutralized by antioxidants, can damage cells and DNA, leading to disease. Sufficient antioxidants are essential for protection.

2. Inflammation – Often driven by a poor diet and gut microbiome imbalances, chronic inflammation damages cells and DNA, contributing to various diseases.

3. Insulin Resistance – Repeated consumption of carbohydrates spikes insulin levels, leading to insulin resistance and, ultimately, Type 2 diabetes. The damage often starts long before diabetes develops.

4. Catabolic Physiology – Stress can trigger a catabolic state, causing the body to break down muscle and even the gut lining to fuel itself. Chronic stress is a significant contributor to this process.

I do believe in the value of an annual physical. Many family doctors perform a more thorough exam than academic physicians, strictly adhering to USPTF guidelines. But the yearly physical isn’t enough. Our bodies are designed to feel amazing—and when they don’t, there’s usually a reason. Even if you feel great, are you actively taking steps to protect yourself from chronic disease? Maybe more can—and should—be done.

Trust your intuition. If you feel something is being missed, you’re probably right.

The belief that “an annual physical is all you need” is, in my view, a lie we learned in medical school.

If you’re interested in exploring a more proactive, comprehensive approach to your health, contact us today to learn more about functional medicine.

References:

1. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018; 319:588.
   
2. Si S, Moss JR, Sullivan TR, et al. Effectiveness of general practice-based health checks: a systematic review and meta-analysis. Br J Gen Pract 2014; 64:e47.
   
3. Woolf SH, Harris R. The harms of screening: new attention to an old concern. JAMA 2012; 307:565.
   
4. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010; 102:605.
5. Bouck Z, Calzavara AJ, Ivers NM, et al. Association of Low-Value Testing With Subsequent Health Care Use and Clinical Outcomes Among Low-risk Primary Care Outpatients Undergoing an Annual Health Examination. JAMA Intern Med 2020; 180:973.