Dr. Nikolas Antoniou has practiced family medicine in the Chicago area for three decades, and he can predict which conversations he is going to repeat in any given week. A patient comes in for a sinus infection and mentions, almost in passing, that they have not had a physical in years. Another schedules a visit because their spouse pushed them to. A third arrives with chest tightness that turned out to be the first warning shot of a heart attack.
In each case, Dr. Antoniou says, the same opportunity was missed earlier. A screening that could have flagged the problem when it was still quiet.
Preventive medicine is not glamorous. It does not produce dramatic recoveries or trending headlines. What it does, when it works, is quietly keep people out of emergency rooms and operating tables. And yet, after thirty years of writing referrals, reviewing labs, and watching the same patterns repeat, Dr. Antoniou has concluded that the screenings most likely to save a life are also the ones adults are most likely to put off.
The screenings adults skip most often
The list is shorter than people expect. Dr. Antoniou points to a handful of tests that should be routine for most adults but consistently fall through the cracks: blood pressure checks done correctly and tracked over time, lipid panels for cholesterol, A1C testing for blood sugar, colorectal cancer screening starting at 45, and age-appropriate cancer screenings including mammograms, cervical screening, prostate discussions, and lung cancer screening for current and former smokers.
None of these are new. And yet, according to data Dr. Antoniou cites from the CDC, only about a quarter of adults are fully up to date on the preventive services recommended for their age and sex.
“Patients tend to think of screenings as something you do when you feel sick,” Dr. Antoniou said. “That is exactly backwards. By the time you feel sick from high blood pressure or early colon cancer, the disease has had years to do damage. The whole point of screening is to find it before you feel anything at all.”
Why people put them off
Dr. Antoniou hears the same explanations on a loop. They feel fine. They are too busy. They are afraid of what the test might show. They had bloodwork three years ago and assume that still counts. They do not have a primary care doctor and do not know where to start.
A patient who avoids a colonoscopy because they are worried about the result is, in practical terms, choosing the worst version of the outcome. Catching a polyp early means a routine removal during the same procedure. Catching a tumor late means surgery, chemotherapy, and a five-year survival conversation that did not have to happen.
“I tell patients all the time, the scan is not what hurts you,” Dr. Antoniou said. “What hurts you is finding out two years too late.”
What a real preventive visit looks like
Part of the problem, Dr. Antoniou argues, is that many adults do not know what a thorough preventive visit should include. A blood pressure cuff and a quick listen to the heart is not a physical. A proper annual visit, in his practice, runs through medication review, family history updates, lifestyle and mental health screening, vaccination status, age-appropriate cancer screening discussions, and a lab panel that catches metabolic issues before they progress.
Family history matters more than most patients realize. A father who had a heart attack at 55 changes the cholesterol conversation. A mother with breast cancer changes the mammogram timeline. A sibling with type 2 diabetes changes how aggressively Dr. Antoniou wants to track A1C numbers.
This is one of the reasons he keeps returning to the value of continuity. A family medicine doctor who has known a patient for years carries context into the conversation. The screening recommendations are the same on paper. The judgment behind which ones to push for, and when, depends on knowing the person.
The age cutoffs that have changed
Some of the resistance to screening comes from outdated information. Patients remember the recommendation from a decade ago and assume it still applies. Several have shifted in ways that matter.
Colorectal cancer screening now starts at 45 for average-risk adults, not 50. The change came from the U.S. Preventive Services Task Force in response to rising rates of colon cancer in younger adults. Lung cancer screening with low-dose CT is now recommended for adults 50 to 80 with a significant smoking history, broader than previous criteria. Hepatitis C screening is now recommended at least once for all adults, not just those with risk factors.
Dr. Antoniou says these shifts catch even attentive patients off guard. They are eligible for screenings they do not know exist, or have aged into recommendations earlier than they expected.
The conversation worth having
For patients who have been putting off a physical, Dr. Antoniou’s advice is direct. Schedule one. Bring a list of questions. Be honest about family history, lifestyle, and any symptoms that have been hovering in the background. Ask which screenings are due now, which are due in the next year, and which can wait.
And for the patients who feel fine, who have always felt fine, who do not see the point of an appointment when nothing is wrong, he offers the same answer he has been offering for thirty years.
“That is when the visit matters most,” Dr. Antoniou said. “Feeling fine is not a diagnosis. It is a starting point. The job of preventive medicine is to make sure feeling fine stays accurate.”
