Overdue for a check-up?

photo of a woman having a blood pressure reading taken in an exam room

Sandra was deeply in denial. Diagnosed with high blood pressure in her 50s, she just didn't want to accept that she was among the 30% to 50% of Americans in her age range with this major risk factor for cardiovascular disease. Sandra stopped making medical appointments and eventually ran out of her blood pressure medication.

But her refusal to seek regular health care led to disastrous results: Sandra suffered a massive stroke. Now in her 80s, "she walks with a limp, while one of her arms is barely usable," says Dr. Daniel Sands, a primary care doctor at Harvard-affiliated Beth Israel Deaconess Medical Center. "She's going to deal with the ramifications for the rest of her life."

Sandra fits into a small but significant group of Americans who eschew regular health evaluations. During the early part of the pandemic, more than 40% of Americans were forced to put off routine or even emergency care, according to the American Medical Association. But while most of those people flocked back after the global crisis eased, many still aren't getting the preventive care they should. About 12% of Americans are unsure when they'll schedule their next check-up, according to a 2024 national poll, and about 20% don't have a primary care doctor.

Such lapses in care can have serious health implications, especially if — like nearly four in 10 Americans — you have at least one chronic condition such as high blood pressure, diabetes, heart disease, or obesity.

Calamitous costs

Skipping regular medical care can increase the odds of potentially perilous consequences. Missing primary care appointments is linked with dying sooner, and the connection is even stronger for people with chronic mental health conditions, a study in BMC Medicine suggests.

But older adults who'd had primary care in the year before they needed emergency surgery were less likely to die within six months of the operation, compared to those who had not received primary care for more than one year, according to a study of 102,384 Medicare patients published online July 19, 2023, by JAMA Surgery.

Delaying care can translate to more wear and tear on the body from any uncontrolled threat, Dr. Sands says. But even if you don't have a chronic health problem, periodic check-ups offer an opportunity to identify risk factors such as smoking, alcohol use, lack of exercise, or poor sleep. They're also a chance to measure weight, blood pressure and cholesterol, go over immunizations, and discuss cancer screenings.

"Most of that stuff isn't urgent and can wait a year," Dr. Sands says. "But I'm more concerned when people with conditions that need to be monitored — such as diabetes, high blood pressure, and obesity—stay away for a long time."

Reasons for a lapse

Why do people stop scheduling check-ups? A 2024 poll of 2,000 adults by U.S. News and World Report revealed a variety of common explanations from those who hadn't seen their primary care doctor in more than a year:

32% said they keep forgetting or have been too busy.
25% said they just don't like going to the doctor.
10% said they'd felt judged or shamed by doctors in the past.

"Some people just fall off the cycle, and before they know it, three, four, or five years pass by because their lives got busy or they were traveling a lot," Dr. Sands says.

When they do finally schedule a check-up, it's often because they've developed a problem they can't ignore, such as back pain. "Sometimes it takes an episode like that," he says. "Or they may have had an unexpected death in the family, start looking at their own health, and realize they haven't seen their doctor in several years."

Restarting care

Dr. Sands offers these tips to smooth the process of reestablishing primary care:

Take stock. If you're still hesitating to make an appointment, examine your goals and how your health is integral to achieving them. "Do you want to live a healthy life so you can play with your grandkids one day and not be winded, or run a marathon?" he asks. "Write your goals down."

Prepare for your visit. Since it's been a while, it's wise to jot down a list of health-related happenings or questions you've pondered in the years since your last appointment. "Write down all the medications you're taking and what you're considering doing, such as starting a special diet or taking a new supplement."

Be patient. If it's been more than a year or two since you've seen your primary care provider, you may find yourself waiting a long time for an appointment. In some communities, primary care physicians are scarce, and this adds to the difficulty in securing an appointment on short notice.

Brace for blowback. If your doctor chides you for stalling, "just own it," Dr. Sands advises. "Say, 'I've had problems following up, but I'm here now making a fresh start.'"

Seeking medical care online? Keep your doctor in the loop

The rise of online-only health care providers has made it possible to connect with clinicians without ever seeing them in person. But while only a fraction of older Americans are using these services, a significant proportion of them haven't told their regular doctor that they're doing so — or that they've gotten a prescription this way, according to a new poll.

Published in January 2024, the National Poll on Healthy Aging survey showed that 7.5% of people between 50 and 80 seek health care and prescriptions from an online-only company, many of which are widely marketed to people seeking treatments for skin problems, sexual health, and hair regrowth. But only one-third of them mentioned it to their health care provider.

The revelation doesn't surprise Dr. Daniel Sands, a primary care doctor at Beth Israel Deaconess Medical Center. "People don't necessarily want their doctor to know they're seeking other sources of health care," he says. And if they're accessing widely available medications, "they may say, 'Why do I need to tell my doctor?'"

But the omission can pose serious implications. Direct-to-consumer services are inarguably convenient, he notes. But they also enable people to receive medical care and prescriptions from clinicians who aren't informed about their full health history and don't have access to their full medical records. Plus, "there probably isn't adequate follow-up," Dr. Sands says.

These virtual practices might also not check for potentially dangerous interactions between the drugs they prescribe and others that patients got elsewhere.

That's the biggest reason Dr. Sands recommends you come clean if you decide to use such a service. "For these issues, I have no problem if you want to seek care somewhere else," he says. "But you need to tell your doctor, because it's important for us to know all the medications our patients are taking."