We were walking up the fairway on the ninth hole when one of my patients asked, “Larry, when should I come in for my annual?” I had a seven-iron in hand, breeze at my back, and I answered without thinking: “Doesn’t matter.” He looked at me like I had just duffed a wedge. To him, it sounded like I did not care. In a way, I suppose I mishit that answer. What I meant was this: the timing of an “annual” exam is about as relevant to your health as whether you tee off at 8:00 a.m. or 1:00 p.m. What matters is showing up, swinging with intention, and keeping the ball in play over the long haul.

The scorecard we should care about

Large trials have looked at this question. The Danish Inter99 trial followed more than 59,000 people: no reduction in death rates from heart disease or cancer. The Cochrane review pooled seventeen randomized studies with over a quarter-million participants: same result, no extension of life. So the annual physical does not lower your handicap when it comes to mortality. What does? Targeted prevention:

• Controlling blood pressure (the straight drive down the middle).
• Helping people quit smoking (avoiding the water hazard).
• Vaccinations (your mulligans against infectious disease).
• Cancer screenings at the right age (laying up smart instead of always going for the green).

The annual as a practice round

The “annual” is really just a scheduled practice round. It gives us both a tee time. It gets you to put your spikes on, show up, and review the course conditions. In that space, we can work on fundamentals: swing tempo, grip pressure, or in real life, sleep, nutrition, and exercise. But golf is not won on the driving range, and health is not won in the exam room once a year. It is won on the course of everyday life: the walks you take, the meals you choose, and the way you manage stress.

A better answer

What I should have told my patient on the fairway was this: “Come in once a year if it helps you keep score and stay accountable. But do not think of it as the tournament. Think of it as a checkpoint, a chance to see if your swing is repeatable and your strategy sound.” Because caring is not about whether the visit is in March or October. It is about being there when your drive slices into the rough, when life hands you a triple bogey, and making sure you still finish the round. In golf, you do not judge the whole season by one hole. In medicine, you do not measure care by one visit. You measure it by consistency, by resilience, and by whether you keep playing the long game.

Larry Kaskel is an internist and “lipidologist in recovery” who has been practicing medicine for more than thirty-five years. He operates a concierge practice in the Chicago area and serves on the teaching faculty at the Northwestern University Feinberg School of Medicine. In addition, he is affiliated with Northwestern Lake Forest Hospital.

Before podcasts entered mainstream culture, Dr. Kaskel hosted Lipid Luminations on ReachMD, where he produced a library of more than four hundred programs featuring leading voices in cardiology, lipidology, and preventive medicine.

He is the author of Dr. Kaskel’s Living in Wellness, Volume One: Let Food Be Thy Medicine, works that combine evidence-based medical practice with accessible strategies for improving healthspan. His current projects focus on reevaluating the cholesterol hypothesis and investigating the infectious origins of atherosclerosis. More information is available at larrykaskel.com.