Dear Dr. Roach: I am a 69-year-old woman. I’m in good health despite various events that happened last year (i.e., a hole in my stomach lining, a loss of consciousness, a platelet-rich plasma injection in my elbow, and shoulder surgery). Also, I have asthma and a history of eosinophilic pneumonia, although it’s been a number of years since I last had it.

At my 2023 physical, the physician assistant did nothing but talk to me about my medications. She didn’t check my heart, lungs, or any of the common things one would expect. I was stunned, and although she has been my provider for three years, I made the decision to find a physician elsewhere.

I found a doctor at a medical hospital facility that I thought would be better, but at my 2024 physical, it was the same thing. She never got anywhere near me. We talked about my medications, then she got up and left the room.

I’m wondering if this is a new trend. I can’t help thinking it’s because I have Medicare. I say this because when trying to find another type of doctor, I was told that few physicians accept Medicare patients. I’m feeling down and vulnerable. If a problem comes up, I have no one to turn to other than urgent care. Please advise.

— F.D.

Answer: I think there’s a misunderstanding here between a regular checkup (sometimes called a “physical”) and an “annual wellness visit” (AWV), which is a specifically defined event approved by Medicare once yearly.

A regular checkup is a time for your regular doctor to evaluate your medical issues. Since you may be seeing specialists for your issues (most primary care doctors don’t do platelet-rich plasma injections and never do shoulder surgery, while eosinophilic pneumonia generally requires subspecialist-level knowledge), your regular doctor may just be checking in with you and reading the notes from your specialists.

A physical exam that is tailored to the patient’s issues is usually done, but there are times when there is so much to talk about that an exam may need to be postponed. A brief discussion about prevention and screening is commonly part of a checkup to help make sure a person is up-to-date.

An AWV is not this at all. It is not intended to manage chronic conditions; instead, “the visit is an opportunity to discuss health concerns, get preventive care recommendations, and develop a plan to improve overall health and well-being.” This may include a health risk assessment, advance care planning, a review of family history, an assessment for medical conditions (including falls, alcohol use and cognitive function), and some prevention like counseling, immunizations, and screening for cancer. The AWV does not include a physical exam.

I have had many patients come in for an annual wellness exam who, like you, are surprised at what the visit does and doesn’t accomplish. People like that it’s a no-cost visit but don’t like that it isn’t a complete checkup. Many doctors will do both an AWV and a checkup (also called a “problem-based visit”) at the same time, but this is obviously more time-consuming and not covered by the billing for an AWV. If a physician does both, they are able to bill the patient for both, which means that the patient will have a co-pay with Medicare.

The biggest problem I see here is a lack of communication. Your doctors should have made it clear what you were and weren’t getting and could have scheduled you for a problem-based visit, either at the same time or on a different day.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.