A check-up every three years is a start, not a plan.

Preventive medicine is the part of medicine intended to prevent disease or detect it early, rather than treat it once it causes symptoms. It works on three levels. Primary prevention acts before a condition arises, through blood pressure, lipids, exercise, smoking cessation and vaccination. Secondary prevention detects a condition that is already present but not yet causing symptoms, which is the field of early detection. Tertiary prevention prevents progression or relapse in existing disease. In Germany part of this is standard care with clear specifications from the Federal Joint Committee, while the rest is self-pay with widely varying evidential strength.

The point in the course of disease. Primary prevention acts before a condition exists: blood pressure lowering, lipid management, endurance training, smoking cessation, vaccination. Secondary prevention finds a condition at a symptom-free stage, including colonoscopy, mammography, skin cancer screening, and blood pressure and lipid measurement as the uncovering of unnoticed risk. Tertiary prevention prevents progression and relapse in existing disease, such as rehabilitation after a heart attack. Some authors add quaternary prevention: protection against overtreatment and against harm from unnecessary diagnostics. That fourth level is the one most often missing in the self-pay market, and we address it explicitly.

Considerably more than many assume, and considerably less than a comprehensive check-up covers. The statutory health check-up is available every three years from the age of 35, and once between 18 and 34, with a medical history, physical examination, a small laboratory profile and a urine test. Added to that are skin cancer screening from 35 every two years, colonoscopy for men from 50 and women from 55, mammography screening for women from 50, cervical cancer screening from 20, a single ultrasound for abdominal aortic aneurysm for men from 65, and low-dose CT screening for the defined lung cancer risk group. Not included are imaging without indication, ApoB and Lp(a), hormone panels and exercise testing.

For the entry level a family doctor covers more than the market suggests. Blood pressure, lipid profile, HbA1c, kidney function, vaccination status, smoking cessation advice and enrolment in the screening programmes are all covered, usually at the expense of statutory insurance. Anyone with something open here gains more from that than from any extended diagnostics. A preventive centre becomes useful in three situations: a family history with early onset, findings that lifestyle cannot explain, and the wish for a complete status in one day rather than specialist appointments spread over months. That is a question of time and clinical question, not of quality.

No, and conflating the two is the most common source of mistaken expectations. Preventive medicine is an established discipline with guidelines, defined programmes and an evidence base on patient-relevant endpoints. Longevity describes a research and market field that treats ageing itself as a modifiable process. The overlap is large: blood pressure, lipids, fitness and sleep are the best-evidenced factors in both fields. The difference lies at the edges, where longevity uses procedures for which no endpoint data exists, such as epigenetic clocks or whole-body MRI without indication. We use such procedures but declare them explicitly as research-adjacent.

Yes, and that belongs in the consultation. Three mechanisms. First, overdiagnosis: a finding that would never have caused symptoms without the test gets treated, with all the risks of treatment and no gain. Second, false positives, which trigger a chain of further investigations, each with its own risk, often ending in nothing. Third, false reassurance from an unremarkable result, which delays the work-up of symptoms later. The question for any procedure is therefore not whether it finds something, but whether the finding triggers an action that improves the course. We declare exactly that chain openly for every procedure.